case_images: PMC10848086_01
case_images: Pre-operative images of the representative case. Magnetic resonance imaging revealed a solid mass occupying the medulla oblongata (A). The lesion exhibited T2 high intensity and was compressing the surrounding structures (B). Homogenous gadolinium enhancement was observed (C, D). The lesion was located at the dorsal aspect of the medulla oblongata and was protruding to the fourth ventricle (E, F). Hydrocephalus was not evident (G).
case_images: cureus-0016-00000051861-i01.jpg
case_images: PMC10848086_01_cureus-0016-00000051861-i01.jpg
case_images: FIG1
case_images: Magnetic resonance imaging (MRI) revealed a homogenously enhancing exophytic lesion arising from the medulla oblongata and extending to the fourth ventricle (Figure 1A-1D). The lesion was spreading through the roof of the fourth ventricle, sparing the floor of the fourth ventricle, vermis, and tonsil (Figure 1E-1F). Hydrocephalus was not present (Figure 1G).
case_images: Intraoperative findings and postoperative images of the representative case. The lesion was pinkish and was surrounded by engorged tortuous vessels (A). The lesion extended along the tela choroidea, and the floor of the fourth ventricle was spared (B). Subtotal resection was performed without any damage to the surrounding vital structures (C). Postoperative imaging revealed sufficient tumor resection without unintentional brainstem damage (D). Histologically, the tumor was composed of small lymphocyte infiltration and pleomorphic tumor cells with large eosinophilic cytoplasm and irregularly shaped nucleus (E). C-kit was positive for the cytoplasm of the tumor cells (F). Follow-up imaging after chemoradiotherapy showed no tumor recurrence (G).
case_images: cureus-0016-00000051861-i02.jpg
case_images: PMC10848086_01_cureus-0016-00000051861-i02.jpg
case_images: FIG2
case_images: The tumor arose from the medulla oblongata's dorsal aspect with an indistinguishable border and protrusion to the cerebellomedullary fissure (Figure 2A). Further, the inner surface of the cerebellum and the floor of the fourth ventricle were intact (Figure 2B). As intraoperative histopathological diagnosis was elusive, subtotal resection was performed (Figure 2C). Postoperative imaging revealed a subtotal resection of the tumor, with no unintentional damage to the surrounding structures (Figure 2D). Histopathological exploration demonstrated abundant infiltration of lymphocytes and sheets of large atypical cells with large, irregularly shaped nuclei and clear cytoplasm, constituting the classical "two-cell pattern" (Figure 2E). Immunohistochemistry showed positive results for c-kit (Figure 2F), podoplanin, and placental alkaline phosphatase. She has been followed up every two months, and no recurrence has been observed 4 months after the surgery (Figure 2G).