Primary Medullary Germinoma:a Case Report And Literature Review

Objective:Primary medullary germinoma is a rare intracranial germinoma.Because of its low incidence and special location,misdiagnosis and mistreatment often occur in the course of clinical diagnosis and treatment.This article reviews the diagnosis and treatment of a case of primary germinoma,and reviews the relevant literature at home and abroad,in order to improve the understanding of the disease,and to provide the diagnosis and treatment ideas for the future diagnosis and treatment of the disease.Methods:A case of primary medullary germinoma admitted to the First Clinical Hospital of Shanxi Medical University in 2016 was retrospectively analyzed.The epidemiology,clinical manifestations,diagnosis,treatment and prognosis of intracranial germinoma were reviewed.Results:The patient underwent surgical treatment(resection of posterior median cranialtumors)in July 2016 and received histopathological biopsy.The results of intraoperative pathological examination were as follows: brainstem germ cell tumors,PLAP(+).In August 2016,prophylactic radiotherapy of whole brain and spinal cord was performed with a dose of 30 Gy plus 14 Gy push irradiation in the residual area of the lesion.Because of pulmonary infection during radiotherapy,no chemotherapy was given,the relevant department was requested.After the consultation,the pulmonary infection was controlled and radiotherapy was continued.The whole course of radiotherapy was completed in October 2016.No recurrence was found on CT in December 2016.Up to now,it has survived for more than 28 months without tumors.The clinical manifestations were numbness and stiffness of both hands and right foot,followed by neck pain.Now the symptoms have been improved obviously,but there are still some body balance dysfunction and fine motor dysfunction,right cheek pain and temperature dysfunction,and bilateral palm skin sensory dysfunction.Conclusion:1.Intracranial germinoma,especially in the deep part of the medulla oblongata,has no specific clinical manifestations.It needs to be judged comprehensively by combining clinical features,imaging findings and serological results.It is best to make a definite histopathological diagnosis.2.For patients with definite diagnosis,radiotherapy should be given as early as possible and neoadjuvant chemotherapy should be given when conditions permit,which can greatly prolong the survival period and improve the quality of life of patients.