gms | German Medical Science

Objective: We present the follow-up of a patient with a malignant undifferenciated neuroepithelial tumor of the medulla oblongata who regained a high quality of life after serious deterioration and a difficult decision for treatment

Method: This 51-year-old woman complained of nausea without any cause in a routine diagnostic. When a paresis of the arm was added to nausea a psychic component was discussed and she was given to a psychiatric department. The psychiatrist ordered an MRI of the brain showing an enhancing partially cystic tumor (24x16 mm) of the medulla oblongata

Results: A biopsy of the tumor was done by a far lateral approach the patient being already hemiparetic and presenting with dysphagia. Histology showed a malignant undifferenciated neuroepithelial tumor. Due to the rapid deterioration of the patient needing already ventilation and a tracheotomy a rescue radiotherapy was done after intensive interdisciplinary discussion and informed consent of the patient. Day by day the patient was transported with the attendance of an anesthesiologist to the radiotherapy unit. Clinical status was ameliorating during the therapy. MRI after 14 days of radiotherapy showed a slight growing of the cystic part of the tumor so that the decision of starting a first cycle of TMZ during radiotherapy was taken. At the end of radiotherapy MRI showed a reduction of the tumor volume. The patient being able to communicate with her lips went into a rehabilitation center, where the second cycle TMZ was given again intravenously. Due to the ongoing amelioration of the patient temozolomide was given orally since the third cycle. She completed 12 cycles without any problem. Actually, MRI shows a small residual contrast enhancing tumor of about 1 mm. The patient is able to walk with only slight hemiparetic symptoms. She leads a normal life at home. There is no intellectual disturbance. We see her for the regular follow-up examinations

Conclusions: Despite a very rapid deterioration we decided to give the patient the chance to profit from an aggressive treatment via an enormous organizational input. This was rewarded by an impressive improvement and a thankful patient living again at home with a high quality of life 24 months after diagnosis. This case shows that it is worthwhile to treat patients aggressively even though the first impression does not seem to justify this effort