1
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Wu HW, Wu CH, Lin SC, Wu CC, Chen HH, Chen YW, Lee YY, Chang FC. MRI features of pediatric atypical teratoid rhabdoid tumors and medulloblastomas of the posterior fossa. Cancer Med 2023; 12:10449-10461. [PMID: 36916326 DOI: 10.1002/cam4.5780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/08/2023] [Accepted: 02/25/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Atypical teratoid rhabdoid tumor (AT/RT) occurs at a younger age and is associated with a worse prognosis than medulloblastoma; however, these two tumor entities are mostly indistinguishable on neuroimaging. The aim of our study was to differentiate AT/RT and medulloblastoma based on their clinical and MRI features to enhance treatment planning and outcome prediction. METHODS From 2005-2021, we retrospectively enrolled 16 patients with histopathologically diagnosed AT/RT and 57 patients with medulloblastoma at our institute. We evaluated their clinical data and MRI findings, including lesion signals, intratumoral morphologies, and peritumoral/distal involvement. RESULTS The age of children with AT/RT was younger than that of children with medulloblastoma (2.8 ± 4.9 [0-17] vs. 6.5 ± 4.0 [0-18], p < 0.001), and the overall survival rate was lower (21.4% vs. 66.0%, p = 0.005). Regarding lesion signals on MRI, AT/RT had a lower ADCmin (cutoff value ≤544.7 × 10-6 mm2 /s, p < 0.001), a lower ADC ratio (cutoff value ≤0.705, p < 0.001), and a higher DWI ratio (cutoff value ≥1.595, p < 0.001) than medulloblastoma. Regarding intratumoral morphology, the "tumor central vein sign" was mostly exclusive to medulloblastoma (24/57, 42.1%; AT/RT 1/16, 6.3%; p = 0.007). Regarding peritumoral invasion on T2WI, AT/RT was more prone to invasion of the brainstem (p < 0.001) and middle cerebellar peduncle (p < 0.001) than medulloblastoma. CONCLUSIONS MRI findings of a lower ADC value, more peritumoral invasion, and absence of the "tumor central vein sign" may be helpful to differentiate AT/RT from medulloblastoma. These distinct MRI findings together with the younger age of AT/RT patients may explain the worse outcomes in AT/RT patients.
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Affiliation(s)
- Hsin-Wei Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Chieh Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chun Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Hung Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wei Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Imaging and Radiological Technology, Yuanpei University of Medical Technology, Hsinchu City, Taiwan
| | - Yi-Yen Lee
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Pediatric Neurosurgery, Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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2
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Romano A, Palizzi S, Romano A, Moltoni G, Di Napoli A, Maccioni F, Bozzao A. Diffusion Weighted Imaging in Neuro-Oncology: Diagnosis, Post-Treatment Changes, and Advanced Sequences-An Updated Review. Cancers (Basel) 2023; 15:cancers15030618. [PMID: 36765575 PMCID: PMC9913305 DOI: 10.3390/cancers15030618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
DWI is an imaging technique commonly used for the assessment of acute ischemia, inflammatory disorders, and CNS neoplasia. It has several benefits since it is a quick, easily replicable sequence that is widely used on many standard scanners. In addition to its normal clinical purpose, DWI offers crucial functional and physiological information regarding brain neoplasia and the surrounding milieu. A narrative review of the literature was conducted based on the PubMed database with the purpose of investigating the potential role of DWI in the neuro-oncology field. A total of 179 articles were included in the study.
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Affiliation(s)
- Andrea Romano
- NESMOS Department, U.O.C. Neuroradiology, “Sant’Andrea” University Hospital, 00189 Rome, Italy
| | - Serena Palizzi
- NESMOS Department, U.O.C. Neuroradiology, “Sant’Andrea” University Hospital, 00189 Rome, Italy
| | - Allegra Romano
- NESMOS Department, U.O.C. Neuroradiology, “Sant’Andrea” University Hospital, 00189 Rome, Italy
| | - Giulia Moltoni
- NESMOS Department, U.O.C. Neuroradiology, “Sant’Andrea” University Hospital, 00189 Rome, Italy
- Correspondence: ; Tel.: +39-3347906958
| | - Alberto Di Napoli
- NESMOS Department, U.O.C. Neuroradiology, “Sant’Andrea” University Hospital, 00189 Rome, Italy
- IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Francesca Maccioni
- Department of Radiology, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Alessandro Bozzao
- NESMOS Department, U.O.C. Neuroradiology, “Sant’Andrea” University Hospital, 00189 Rome, Italy
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3
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Jarry VDM, Pereira FV, Dalaqua M, Duarte JÁ, França Junior MC, Reis F. Common and uncommon neuroimaging manifestations of ataxia: an illustrated guide for the trainee radiologist. Part 2 - neoplastic, congenital, degenerative, and hereditary diseases. Radiol Bras 2022; 55:259-266. [PMID: 35983347 PMCID: PMC9380611 DOI: 10.1590/0100-3984.2021.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/09/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract Ataxia is defined as a lack of coordination of voluntary movement, caused by a variety of factors. Ataxia can be classified by the age at onset and type (chronic or acute). The causative lesions involve the cerebellum and cerebellar connections. The correct, appropriate use of neuroimaging, particularly magnetic resonance imaging, can make the diagnosis relatively straightforward and facilitate implementation of the appropriate clinical management. The purpose of this pictorial essay is to describe the imaging findings of ataxia, based on cases obtained from the archives of a tertiary care hospital, with a review of the most important findings. We also discuss and review the imaging aspects of neoplastic diseases, malformations, degenerative diseases, and hereditary diseases related to ataxia.
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Affiliation(s)
| | | | | | | | | | - Fabiano Reis
- Universidade Estadual de Campinas (Unicamp), Brazil
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4
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Eibl T, Hammer A, Yakubov E, Blechschmidt C, Kalisch A, Steiner HH. Medulloblastoma in adults - reviewing the literature from a surgeon's point of view. Aging (Albany NY) 2021; 13:3146-3160. [PMID: 33497354 PMCID: PMC7880386 DOI: 10.18632/aging.202568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/04/2021] [Indexed: 06/12/2023]
Abstract
Medulloblastoma is a common primary brain tumor in children but it is a rare cancer in adult patients. We reviewed the literature, searching PubMed for articles on this rare tumor entity, with a focus on tumor biology, advanced neurosurgical opportunities for safe tumor resection, and multimodal treatment options. Adult medulloblastoma occurs at a rate of 0.6 per one million people per year. There is a slight disparity between male and female patients, and patients with a fair skin tone are more likely to have a medulloblastoma. Patients present with cerebellar signs and signs of elevated intracranial pressure. Diagnostic efforts should consist of cerebral MRI and MRI of the spinal axis. Cerebrospinal fluid should be investigated to look for tumor dissemination. Medulloblastoma tumors can be classified as classic, desmoplastic, anaplastic, and large cell, according to the WHO tumor classification. Molecular subgroups include WNT, SHH, group 3, and group 4 tumors. Further molecular analyses suggest that there are several subgroups within the four existing subgroups, with significant differences in patient age, frequency of metastatic spread, and patient survival. As molecular markers have started to play an increasing role in determining treatment strategies and prognosis, their importance has increased rapidly. Treatment options include microsurgical tumor resection and radiotherapy and, in addition, chemotherapy that respects the tumor biology of individual patients offers targeted therapeutic approaches. For neurosurgeons, intraoperative imaging and tumor fluorescence may improve resection rates. Disseminated disease, residual tumor after surgery, lower radiation dose, and low Karnofsky performance status are all suggestive of a poor outcome. Extraneural spread occurs only in very few cases. The reported 5-year-survival rates range between 60% and 80% for all adult medulloblastoma patients.
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Affiliation(s)
- Thomas Eibl
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Alexander Hammer
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Eduard Yakubov
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Cristiane Blechschmidt
- Department of Neuropathology, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Alexander Kalisch
- Department of Oncology, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
| | - Hans-Herbert Steiner
- Department of Neurosurgery, Paracelsus Medical University, Nuremberg 90471, Bavaria, Germany
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5
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Akiyama N, Uesaka K, Tanaka Y, Hiasa J, Watanabe KI, Horiuchi N, Kobayashi Y, Inokuma H. A clinical case of presumed cerebellar medulloblastoma in a Japanese Black calf with increased neuron-specific enolase in cerebrospinal fluid. J Vet Med Sci 2020; 82:1436-1439. [PMID: 32741886 PMCID: PMC7653316 DOI: 10.1292/jvms.20-0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 2-day-old Japanese Black male calf that presented with opisthotonos with spastic
extension of all four limbs and nystagmus was presented. Evaluation of cranial neurology
revealed a horizontal slow nystagmus and absence of menace response in the left eye.
Necropsy revealed a mass located between the posterior margin of the cerebrum and anterior
margin of the cerebellum, and continuously with the cerebellar lesion. The brainstem was
severely compressed by those lesions. Original structures of the cerebellum were mostly
replaced by grayish-white and brownish tissues. Those lesions were diagnosed as presumed
cerebellar medulloblastoma by histopathological and immunohistochemical examination. As
neuron-specific enolase in the cerebrospinal fluid which is a biomarker for neuronal
damage was increased compared with healthy calves.
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Affiliation(s)
- Nao Akiyama
- Veterinary Medical Center, Graduate School of Agriculture and Life Science, The University of Tokyo, Tokyo 113-8657, Japan
| | - Karin Uesaka
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan.,United Graduate School of Veterinary Science, Gifu University, Gifu 501-1193, Japan
| | - Yusuke Tanaka
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan.,United Graduate School of Veterinary Science, Gifu University, Gifu 501-1193, Japan
| | - Jun Hiasa
- Shihoro Agricultural Cooperatives, Shihoro, Hokkaido 080-1200, Japan
| | - Ken-Ichi Watanabe
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan
| | - Noriyuki Horiuchi
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan.,United Graduate School of Veterinary Science, Gifu University, Gifu 501-1193, Japan
| | - Yoshiyasu Kobayashi
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Hokkaido 080-8555, Japan.,United Graduate School of Veterinary Science, Gifu University, Gifu 501-1193, Japan
| | - Hisashi Inokuma
- Veterinary Medical Center, Graduate School of Agriculture and Life Science, The University of Tokyo, Tokyo 113-8657, Japan
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6
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Dangouloff-Ros V, Varlet P, Levy R, Beccaria K, Puget S, Dufour C, Boddaert N. Imaging features of medulloblastoma: Conventional imaging, diffusion-weighted imaging, perfusion-weighted imaging, and spectroscopy: From general features to subtypes and characteristics. Neurochirurgie 2018; 67:6-13. [PMID: 30170827 DOI: 10.1016/j.neuchi.2017.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/13/2017] [Accepted: 10/29/2017] [Indexed: 12/13/2022]
Abstract
Medulloblastoma is a frequent high-grade neoplasm among pediatric brain tumours. Its classical imaging features are a midline tumour growing into the fourth ventricle, hyperdense on CT-scan, displaying a hypersignal when using diffusion-weighted imaging, with a variable contrast enhancement. Nevertheless, atypical imaging features have been widely reported, varying according to the age of the patient, and histopathological subtype. In this study, we review the classical and atypical imaging features of medulloblastomas, with emphasis on advanced MRI techniques, histopathological and molecular subtypes and characteristics, and follow-up modalities.
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Affiliation(s)
- V Dangouloff-Ros
- Department of pediatric radiology, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France; Inserm U1000, 149, rue de Sèvres, 75015 Paris, France; University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France.
| | - P Varlet
- University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; Department of neuropathology, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - R Levy
- Department of pediatric radiology, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France; Inserm U1000, 149, rue de Sèvres, 75015 Paris, France; University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France
| | - K Beccaria
- University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; Department of pediatric neurosurgery, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France
| | - S Puget
- University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; Department of pediatric neurosurgery, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France
| | - C Dufour
- Department of pediatric and adolescent oncology, Gustave-Roussy Institute, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - N Boddaert
- Department of pediatric radiology, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75105 Paris, France; Inserm U1000, 149, rue de Sèvres, 75015 Paris, France; University René-Descartes, PRES-Sorbonne-Paris-Cité, 12, rue de l'École-de-Médecine, Paris, France; UMR 1163, institut Imagine, 24, boulevard du Montparnasse, 75015 Paris, France
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7
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Mata-Mbemba D, Donnellan J, Krishnan P, Shroff M, Muthusami P. Imaging Features of Common Pediatric Intracranial Tumours: A Primer for the Radiology Trainee. Can Assoc Radiol J 2018; 69:105-117. [DOI: 10.1016/j.carj.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daddy Mata-Mbemba
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Donnellan
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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8
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Song SS, Wang JH, Fu WW, Li Y, Sui QL, Liu XJ. Medulloblastoma with Atypical Dynamic Imaging Changes: Case Report with Literature Review. World Neurosurg 2017. [PMID: 28625899 DOI: 10.1016/j.wneu.2017.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We analyzed a case of medulloblastoma with atypical dynamic imaging changes retrospectively to summarize the atypical magnetic resonance imaging (MRI) features of medulloblastoma by reviewing the literature. METHODS An atypical case of medulloblastoma in the cerebellar hemisphere confirmed by pathology was analyzed retrospectively, and the literature about it was reviewed. RESULTS The radiologic findings of the patient were based on 3 examinations. The first examination showed that the cortex of the bilateral cerebellar hemisphere had diffuse nodular thickening, with a high signal on diffusion-weighted imaging and significant enhancement. Contrast enhancement MRI 1 year later showed the signal of cerebellar hemisphere returned to normal but revealed an enhanced nodule. A reexamination 6 months later showed an irregular mass with a high-density shadow in the cerebellar vermis on CT scan. The T2-weighted image revealed multiple degenerative cysts, and the mass had significant enhancement. CONCLUSION The radiologic characteristics of atypical medulloblastomas vary in adults and children. Understanding the radiologic characteristics of medulloblastomas, such as MRI features, age of onset, and location of atypical medulloblastomas, can help improve the diagnosis of medulloblastomas.
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Affiliation(s)
- Shuang-Shuang Song
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jian-Hong Wang
- Organ Transplantation Center, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wei-Wei Fu
- Department of Pathology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying Li
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qing-Lan Sui
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xue-Jun Liu
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, China.
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9
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Abstract
Medulloblastoma accounts for nearly 10% of all childhood brain tumors. These tumors occur exclusively in the posterior fossa and have the potential for leptomeningeal spread. Treatment includes a combination of surgery, radiation therapy (in patients >3 years old). Patients >3 years old are stratified based on the volume of postoperative residual tumor and the presence or absence of metastases into "standard risk" and "high risk" categories with long-term survival rates of approximately 85% and 70%, respectively. Outcomes are inferior in infants and children younger than 3 years with exception of those patients with the medulloblastoma with extensive nodularity histologic subtype. Treatment for medulloblastoma is associated with significant morbidity, especially in the youngest patients. Recent molecular subclassification of medulloblastoma has potential prognostic and therapeutic implications. Future incorporation of molecular subgroups into treatment protocols will hopefully improve both survival outcomes and posttreatment quality of life.
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Affiliation(s)
- Nathan E Millard
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kevin C De Braganca
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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10
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New Concepts in the Imaging of Pediatric Brain Tumors: The Revival of Age-old Real Estate Principles. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Brandes AA, Franceschi E. Shedding light on adult medulloblastoma: current management and opportunities for advances. Am Soc Clin Oncol Educ Book 2015:e82-7. [PMID: 24857151 DOI: 10.14694/edbook_am.2014.34.e82] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Few evidence-based guidelines are available for the treatment of adult medulloblastoma, an extremely rare disease. Therapeutic regimens, typically modeled following pediatric protocols, consist of surgical resection followed by radiotherapy with or without adjuvant chemotherapy. Because of the rarity of this disease in adults, any treatment undertaken is based mainly on small and retrospective studies. Unlike pediatric patients, adults with medulloblastoma have been treated according to risk-adapted therapeutic strategies in only a few prospective studies. Overall, approximately 30% of patients experience recurrence and die of disease-related causes. Although the patients could respond to second-line treatments, the prognosis of patients with recurrence remains dismal. An important challenge for the future will be the biologic characterization of medulloblastoma in adults, with the identification of specific genetic patterns of patients with different prognosis and different response to targeted treatments.
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Affiliation(s)
- Alba A Brandes
- From the Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Science, Bologna, Italy
| | - Enrico Franceschi
- From the Department of Medical Oncology, Azienda USL-IRCCS Institute of Neurological Science, Bologna, Italy
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12
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Patay Z, DeSain LA, Hwang SN, Coan A, Li Y, Ellison DW. MR Imaging Characteristics of Wingless-Type-Subgroup Pediatric Medulloblastoma. AJNR Am J Neuroradiol 2015; 36:2386-93. [PMID: 26338912 DOI: 10.3174/ajnr.a4495] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE "Transcriptionally different" medulloblastoma groups are associated with specific signaling pathway abnormalities; hence, they may present with distinct imaging manifestations. In this study, we sought to describe the MR imaging features of wingless-type-subgroup medulloblastomas with embryologic correlations. MATERIALS AND METHODS Pre- and postoperative imaging studies of 16 patients with wingless-type-subgroup medulloblastoma were evaluated for tumor location, involvement of surrounding CSF spaces or parenchymal structures, conventional and DWI signal properties, and postsurgical damage patterns. Laterality scores were assigned to tumors at each step in the evaluation process. Continuous variables were summarized by using descriptive statistics. The Wilcoxon signed rank test was performed to compare laterality scores. To determine the interobserver variability, we computed the intraclass correlation and Cohen κ coefficients. RESULTS Wingless-type-subgroup medulloblastomas in our series were histopathologically "classic." Wingless-type-subgroup medulloblastomas occur in specific sites, with involvement of the foramen of Luschka (75%), the fourth ventricle (68.75%), the cisterna magna (31.25%), and the cerebellopontine angle cistern (18.75%). Laterality scores were low (<2) when preoperative primary and secondary anatomic features were evaluated separately, but they increased (>2) when all pre- and postoperative anatomic features were considered. Results were statistically shown to be reproducible (interclass correlation coefficient, 0.71-0.94; Cohen κ, 0.63-1.00). On the basis of anatomic lesion patterns, 4 location-based subtypes may be distinguished: 1) midline-intraventricular, 2) midline-extraventricular, 3) off-midline-intraventricular, and 4) off-midline-extraventricular, which represent a continuum. CONCLUSIONS Wingless-type-subgroup medulloblastomas are lateralized tumors arising from the brain stem and cerebellum around the foramen of Luschka. Our current understanding of their embryologic origins is in concordance with the spatial distribution of these tumors.
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Affiliation(s)
- Z Patay
- From the Departments of Diagnostic Imaging (Z.P., L.A.D., S.N.H.)
| | - L A DeSain
- From the Departments of Diagnostic Imaging (Z.P., L.A.D., S.N.H.)
| | - S N Hwang
- From the Departments of Diagnostic Imaging (Z.P., L.A.D., S.N.H.)
| | - A Coan
- Biostatistics (A.C., Y.L.)
| | - Y Li
- Biostatistics (A.C., Y.L.)
| | - D W Ellison
- Pathology (D.W.E.), St. Jude Children's Research Hospital, Memphis, Tennessee
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13
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Suero-Abreu GA, Praveen Raju G, Aristizábal O, Volkova E, Wojcinski A, Houston EJ, Pham D, Szulc KU, Colon D, Joyner AL, Turnbull DH. In vivo Mn-enhanced MRI for early tumor detection and growth rate analysis in a mouse medulloblastoma model. Neoplasia 2015; 16:993-1006. [PMID: 25499213 PMCID: PMC4309249 DOI: 10.1016/j.neo.2014.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/25/2014] [Accepted: 10/01/2014] [Indexed: 12/03/2022] Open
Abstract
Mouse models have increased our understanding of the pathogenesis of medulloblastoma (MB), the most common malignant pediatric brain tumor that often forms in the cerebellum. A major goal of ongoing research is to better understand the early stages of tumorigenesis and to establish the genetic and environmental changes that underlie MB initiation and growth. However, studies of MB progression in mouse models are difficult due to the heterogeneity of tumor onset times and growth patterns and the lack of clinical symptoms at early stages. Magnetic resonance imaging (MRI) is critical for noninvasive, longitudinal, three-dimensional (3D) brain tumor imaging in the clinic but is limited in resolution and sensitivity for imaging early MBs in mice. In this study, high-resolution (100 μm in 2 hours) and high-throughput (150 μm in 15 minutes) manganese-enhanced MRI (MEMRI) protocols were optimized for early detection and monitoring of MBs in a Patched-1 (Ptch1) conditional knockout (CKO) model. The high tissue contrast obtained with MEMRI revealed detailed cerebellar morphology and enabled detection of MBs over a wide range of stages including pretumoral lesions as early as 2 to 3 weeks postnatal with volumes close to 0.1 mm3. Furthermore, longitudinal MEMRI allowed noninvasive monitoring of tumors and demonstrated that lesions within and between individuals have different tumorigenic potentials. 3D volumetric studies allowed quantitative analysis of MB tumor morphology and growth rates in individual Ptch1-CKO mice. These results show that MEMRI provides a powerful method for early in vivo detection and longitudinal imaging of MB progression in the mouse brain.
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Affiliation(s)
- Giselle A Suero-Abreu
- Skirball Institute of Biomolecular Medicine and Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - G Praveen Raju
- Developmental Biology Department, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Orlando Aristizábal
- Skirball Institute of Biomolecular Medicine and Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - Eugenia Volkova
- Skirball Institute of Biomolecular Medicine and Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - Alexandre Wojcinski
- Developmental Biology Department, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Edward J Houston
- Skirball Institute of Biomolecular Medicine and Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - Diane Pham
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Kamila U Szulc
- Skirball Institute of Biomolecular Medicine and Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - Daniel Colon
- Skirball Institute of Biomolecular Medicine and Department of Radiology, NYU School of Medicine, New York, NY, USA
| | - Alexandra L Joyner
- Developmental Biology Department, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniel H Turnbull
- Skirball Institute of Biomolecular Medicine and Department of Radiology, NYU School of Medicine, New York, NY, USA.
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Han C, Zhao L, Zhong S, Wu X, Guo J, Zhuang X, Han H. A comparison of high b-value vs standard b-value diffusion-weighted magnetic resonance imaging at 3.0 T for medulloblastomas. Br J Radiol 2015; 88:20150220. [PMID: 26235143 DOI: 10.1259/bjr.20150220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the utility of diffusion-weighted (DW) MRI using high b-value vs standard b-value for patients with medulloblastoma (MB). Minimum apparent diffusion coefficient (ADCMIN) values were also compared with tumour cellularity. METHODS High and standard b-value DW images were obtained for 17 patients with MB. The number and location of the lesions, signal intensities (SIs), signal-to-noise ratios (SNRs), contrast-to-noise ratios, contrast ratios (CRs) and ADCs of the lesions were compared. Tumour cellularity was also measured and compared with ADCMIN values. RESULTS All 20 lesions were hyperintense on the DW MR images with high and standard b-values. Four additional lesions were revealed on high b-value, and all 24 lesions were more conspicuous at high b-value. SI, SNR and ADC values for the lesions were lower in the high b-value images than in the standard b-value images. The ADCMIN value at b = 3000 s mm(-2) was more significantly associated with tumour cellularity than that at b = 1000 s mm(-2). CR values were significantly higher in the high b-value images than in the standard b-value images. CONCLUSION DW imaging using high b-value may be beneficial for detecting additional, less prominent lesions and may improve the contrast between MB lesions and normal tissue. A stronger inverse correlation with tumour cellularity was identified using the ADCMIN values at high b-value. ADVANCES IN KNOWLEDGE This study demonstrates the superiority of high b-value DW imaging compared with standard b-value imaging for the detection of MB lesions, especially those with subtle foci.
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Affiliation(s)
- Chengkun Han
- 1 Department of Neuroradiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Long Zhao
- 2 Department of Nuclear Medicine & Minnan PET Center, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Shan Zhong
- 3 Department of Pathology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiurong Wu
- 1 Department of Neuroradiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jianfeng Guo
- 4 Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Xiongjie Zhuang
- 1 Department of Neuroradiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Haiwei Han
- 1 Department of Neuroradiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
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Brandes AA, Bartolotti M, Marucci G, Ghimenton C, Agati R, Fioravanti A, Mascarin M, Volpin L, Ammannati F, Masotto B, Gardiman MP, De Biase D, Tallini G, Crisi G, Bartolini S, Franceschi E. New perspectives in the treatment of adult medulloblastoma in the era of molecular oncology. Crit Rev Oncol Hematol 2015; 94:348-59. [PMID: 25600839 DOI: 10.1016/j.critrevonc.2014.12.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 12/10/2014] [Accepted: 12/23/2014] [Indexed: 02/08/2023] Open
Abstract
Medulloblastoma is the most common central nervous system tumor in children, while it is extremely rare in adults. Multimodal treatment involving surgery, radiotherapy and chemotherapy can improve the prognosis of this disease, and recent advances in molecular biology have allowed the identification of molecular subgroups (WNT, SHH, Groups 3 and 4), each of which have different cytogenetic, mutational and gene expression signatures, demographics, histology and prognosis. The present review focuses on the state of the art for adult medulloblastoma treatment and on novel molecular advances and their future implications in the treatment of this disease.
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Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy.
| | - Marco Bartolotti
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Gianluca Marucci
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), University, of Bologna, Section of Pathology, M. Malpighi, Bellaria Hospital, Bologna, Italy
| | | | - Raffaele Agati
- Department of Neuroradiology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Antonio Fioravanti
- Department of Neurosurgery, Bellaria Hospital - IRCCS Institute of Neurological Sciences, Azienda USL, Bologna, Italy
| | | | - Lorenzo Volpin
- Department of Neuroscience and Neurosurgery, San Bortolo Hospital, Vicenza, Italy
| | - Franco Ammannati
- Department of Neurosurgery I, Careggi University Hospital, Firenze, Italy
| | - Barbara Masotto
- Section of Neurosurgery, Department of Neuroscience, University of Verona, Verona, Italy
| | - Marina Paola Gardiman
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University Hospital, Padova, Italy
| | - Dario De Biase
- Department of Medicine (DIMES) - Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Department of Medicine (DIMES) - Anatomic Pathology Unit, Bellaria Hospital, University of Bologna, Bologna, Italy
| | - Girolamo Crisi
- Department of Neuroradiology, Parma University Hospital, Parma, Italy
| | - Stefania Bartolini
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
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A Rare Case of Medulloblastoma with Excessive Nodularity: Imagistic Features. ROMANIAN NEUROSURGERY 2014. [DOI: 10.2478/romneu-2014-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Medulloblastoma is the most common malignant tumor of childhood. Neuroimaging can play a role in the diagnosis of medulloblastoma, however atypical features do exist [2]. We report the case of a 1 year and 10- month-old infant diagnosed with a medulloblastoma with what we term “excessive” nodularity based on neuroimaging features and confirmed by neuropathology. CT-scan (CT) and magnetic resonance imaging (MRI) examination of the brain revealed a very large posterior fossa tumor attached to tentorium. On T2-weighted and post-gadolinium sequences, the tumor shows an extensive nodular grape-like appearance. Initial the patient was underwent a ventriculo-peritoneal shunt. The second operative procedure was tumour resection. Histology examen revealed a diagnosis of medulloblastoma desmoplastic with extensive nodularity. The neuroradiographic features of this medulloblastoma with what we describe as “excessive” nodularity are important to recognize as these children may be cured with chemotherapy alone.
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Hoang DH, Pagnier A, Guichardet K, Dubois-Teklali F, Schiff I, Lyard G, Cousin E, Krainik A. Cognitive disorders in pediatric medulloblastoma: what neuroimaging has to offer. J Neurosurg Pediatr 2014; 14:136-44. [PMID: 24950472 DOI: 10.3171/2014.5.peds13571] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Medulloblastomas are the most common malignant childhood brain tumors arising in the posterior fossa. Treatment improvements for these tumors have meant that there are a greater number of survivors, but this long-term patient survival has increased the awareness of resulting neurocognitive deficits. Impairments in attention, memory, executive functions, and intelligence quotient demonstrate that the cerebellum likely plays a significant role in numerous higher cognitive functions such as language, cognitive, and emotional functions. In addition, children with medulloblastoma not only have cerebellar lesions but also brain white matter damages due to radiation and chemotherapy. Functional neuroimaging, a noninvasive method with many advantages, has become the standard tool in clinical and cognitive neuroscience research. By reviewing functional neuroimaging studies, this review aims to clarify the role of the cerebellum in cognitive function and explain more clearly cognitive sequelae due to polytherapy in children with medulloblastoma. This review suggests that the posterior cerebellar lobes are crucial to maintaining cognitive performance. Clinical investigations could help to better assess the involvement of these lobes in cognitive functions.
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Affiliation(s)
- Duc Ha Hoang
- Department of Radiology, University Hospital Viettiep, Haiphong, Vietnam
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18
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Meshkini A, Vahedi A, Meshkini M, Alikhah H, Naghavi-Behzad M. Atypical medulloblastoma: A case series. Asian J Neurosurg 2014; 9:45-7. [PMID: 24891891 PMCID: PMC4038867 DOI: 10.4103/1793-5482.131077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Medulloblastoma is common in children as a tumor of midline posterior fossa, which arises from vermis and appears as a homogenously enhancing hyperdense mass on computed tomography scan and is associated with the clinical picture of posterior fossa syndrome. This unique clinic-radiological pattern in considered “typical” medulloblastoma, but medulloblastomas does not follow the typical clinic-radiological pattern in a significant number of children and adult cases. We review here the previous reports of atypical or uncommon features of medulloblastoma and add our very rare atypical cases of medulloblastomas to this list. Medulloblastoma should be considered in all midline posterior fossa tumors, hemisphere and cerebellopontine angle despite having clinical and radiological features suggestive of other tumors. Definitive diagnosis requires histologic confirmation in all cases.
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Affiliation(s)
- Ali Meshkini
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Vahedi
- Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Meshkini
- Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Alikhah
- Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naghavi-Behzad
- Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ; Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Kanoto M, Toyoguchi Y, Hosoya T, Kuchiki M, Sugai Y. Radiological image features of the atypical teratoid/rhabdoid tumor in adults: a systematic review. Clin Neuroradiol 2014; 25:55-60. [PMID: 24477665 DOI: 10.1007/s00062-013-0282-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Atypical teratoid/rhabdoid tumor (AT/RT) occurs in children less than 3 years old, and has a very poor prognosis. AT/RT seldom occurs in adult. We have experienced four cases of AT/RT at our institute. The purpose of this study is to evaluate the radiological image findings of adult-onset AT/RT and to conduct a systematic review. METHODS Image findings of four AT/RTs in our institute were retrospectively evaluated by an experienced neuroradiologist. If the images were unavailable, image findings were evaluated from the former image interpretation report. We assembled papers of adult-onset AT/RT (n = 38) and evaluated the image findings. RESULTS AT/RT occurs in a variety of sites (spinal region, pineal region, suprasellar region, jugular foramen, and so on). High density on computed tomography (CT) was seen in 10 of 11 cases; mixed intensity in T2-weighted image was seen in 13 of 18 cases; and high intensity on diffusion-weighted image (DWI) was seen in 3 of 3 cases. Contrast enhancement was observed in all cases in which images were available. CONCLUSIONS We have experienced four adult-onset AT/RT cases at our institute and have evaluated image findings through systematic review. The image findings of high density on CT, high intensity on DWI, with low apparent diffusion coefficient, and a heterogenous component should lead to an inclusion of AT/RT in the differential diagnosis of a tumor; these findings may be able to suggest AT/RT; however, they cannot make the diagnosis.
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Affiliation(s)
- M Kanoto
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, 990-9585, Yamagata, Japan,
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Abstract
OBJECTIVE We hypothesized that the apparent diffusion coefficient (ADC) and other MRI features can be used to predict medulloblastoma histologic subtypes, as defined by the World Health Organization (WHO) in WHO Classification of Tumours of the Central Nervous System. MATERIALS AND METHODS A retrospective review of pediatric patients with medulloblastoma between 1989 and 2011 identified 38 patients with both pretreatment MRI and original pathology slides. The mean and minimum tumor ADC values and conventional MRI features were compared among medulloblastoma histologic subtypes. RESULTS The cohort of 38 patients included the following histologic subtypes: 24 classic medulloblastomas, nine large cell (LC) or anaplastic medulloblastomas, four desmoplastic medulloblastomas, and one medulloblastoma with extensive nodularity. The median age at diagnosis was 8 years (range, 1-21 years) and the median follow-up time was 33 months (range, 0-150 months). The mean ADC (× 10(-3) mm(2)/s) was lower in classic medulloblastoma (0.733 ± 0.046 [SD]) than in LC or anaplastic medulloblastoma (0.935 ± 0.127) (Mann-Whitney test, p = 0.004). Similarly, the minimum ADC was lower in classic medulloblastoma (average ± SD, 0.464 ± 0.056) than in LC or anaplastic medulloblastoma (0.630 ± 0.053) (p = 0.004). The MRI finding of focal cysts correlated with the classic and desmoplastic subtypes (Fisher exact test, p = 0.026). Leptomeningeal enhancement positively correlated with the LC or anaplastic medulloblastoma subtype and inversely correlated with the classic medulloblastoma and desmoplastic medulloblastoma subtypes (p = 0.04). Ring enhancement correlated with tumor necrosis (p = 0.022) and with the LC or anaplastic medulloblastoma histologic subtype (p < 0.001). CONCLUSION The LC or anaplastic medulloblastoma subtype was associated with increased ADC and with ring enhancement, the latter of which correlated with tumor necrosis. These features could be considered in the evaluation of high-risk medulloblastoma subtypes.
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A contemporary review of molecular candidates for the development and treatment of childhood medulloblastoma. Childs Nerv Syst 2013; 29:381-8. [PMID: 23292496 DOI: 10.1007/s00381-012-2014-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 12/22/2012] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Medulloblastoma is the most common pediatric central nervous system tumor; however, the causes are not well established. There has been some emphasis on mutations in developmental pathways and their impact on tumor pathology in hereditary diseases, but, in order to better understand the nature of diseases like medulloblastoma, other mechanisms also require attention. PURPOSE The purpose of this review is to provide an overview of the main genes involved in neurodevelopment, their downstream targets, and modulatory links by growth factors. Occurrence of pediatric brain tumors including medulloblastoma are mostly sporadic, but some hereditary diseases like Li-Fraumeni syndrome, Gorlin's syndrome, Turcot's syndrome, and Rubenstein-Tarbi syndrome are known to contribute their development as consequences of germline mutations at specific points: DNA-repairing gene Tp53 for Li-Fraumeni syndrome or Patch for Gorlin's, and apoptosis-related gene product adenomatous polyposis coli for Turcot's disease. CONCLUSION Intracellular relations at molecular level and future therapeutics that specifically target the corresponding pathways should be well understood in order to prevent and cure childhood medulloblastoma.
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Spina A, Boari N, Gagliardi F, Franzin A, Terreni MR, Mortini P. Review of cerebellopontine angle medulloblastoma. Br J Neurosurg 2012; 27:316-20. [PMID: 23163297 DOI: 10.3109/02688697.2012.741733] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cerebellopontine angle (CPA) medulloblastomas (MB) are rare lesions with few cases previously described in the literature. We report two further cases of CPA MB. The patients were a 22-year-old man and a 26-year-old woman with a mass developing in the CPA. The preoperative radiological diagnosis was vestibular schwannoma in the first case and petrosal meningioma in the second case. The patients were operated on through a retrosigmoid approach. The intraoperative findings revealed an intra-axial tumour and the histological diagnosis was classic type of MB in both cases. We review the literature and discuss pathological and radiological features and possible pathogenesis of CPA MB, underlining the necessity to consider MB in the differential diagnosis of CPA lesions.
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Affiliation(s)
- A Spina
- Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. spina.alfi
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23
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Medulloblastoma with excessive nodularity: radiographic features and pathologic correlate. Case Rep Radiol 2012; 2012:310359. [PMID: 23133782 PMCID: PMC3485496 DOI: 10.1155/2012/310359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/02/2012] [Indexed: 11/18/2022] Open
Abstract
Medulloblastoma with extensive nodularity is a rare subtype of the most common malignant childhood brain tumor and has been associated with more favorable prognosis. The authors report the case of a 10-month-old girl with a posterior fossa tumor of excessive nodularity with decreased diffusivity on diffusion-weighted magnetic resonance imaging sequences and robust grape-like postgadolinium contrast enhancing features. The unique neuroradiographic features were confirmed by histopathology and a diagnosis of medulloblastoma with extensive nodularity was made. This case highlights the importance of recognizing this unique medulloblastoma subtype preoperatively, as the more favorable outcome may preclude less aggressive medical management.
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Aguilar HN, Hung RW, Mehta V, Kotylak T. Imaging characteristics of an unusual, high-grade angiocentric glioma: a case report and review of the literature. J Radiol Case Rep 2012; 6:1-10. [PMID: 23378871 DOI: 10.3941/jrcr.v6i10.1134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Angiocentric gliomas have recently been reclassified as a separate central nervous system tumor. Few cases have been reported, and most of those correspond to slow-growing, low-grade neoplasms in very young pediatric patients. Here we describe magnetic resonance imaging findings (including diffusion imaging, spectroscopy and tractography) in an unusual higher-grade neoplasm with pathologic features suggestive of an angiocentric glioma in a 15-year-old male. The tumor had mild heterogeneous enhancement on magnetic resonance imaging, and a low apparent diffusion coefficient (9.9 × 10(-4) mm(2)s(-1)), consistent with an intermediate-to-high cellularity tumor. Spectroscopic imaging showed elevated choline/phosphocreatine and choline/N-acetyl aspartate ratios, suggesting an unusually aggressive tumor. We conclude that angiocentric glioma should not be excluded from consideration at primary diagnosis, particularly in teenaged patients nearing adulthood.
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Affiliation(s)
- Hector N Aguilar
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
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Zhang M, Ou Y, Zhang H, Zhang J, Xia L, Qu Y, Wang H, Zhan Q, Song Y, Yu C. Leptomeningeal metastasis from central nervous system tumors: A study of classification and stage in the spinal canal of 58 patients. CHINESE SCIENCE BULLETIN-CHINESE 2012. [DOI: 10.1007/s11434-012-5262-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu HQ, Yin X, Li Y, Zhang J, Wang Y, Tchoyoson Lim C, Feng X. MRI features in children with desmoplastic medulloblastoma. J Clin Neurosci 2012; 19:281-5. [DOI: 10.1016/j.jocn.2011.04.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 04/02/2011] [Indexed: 10/14/2022]
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Poretti A, Meoded A, Huisman TAGM. Neuroimaging of pediatric posterior fossa tumors including review of the literature. J Magn Reson Imaging 2011; 35:32-47. [PMID: 21989968 DOI: 10.1002/jmri.22722] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 06/23/2011] [Indexed: 01/06/2023] Open
Abstract
Conventional, anatomical MRI is an essential tool for diagnosis and evaluation of location, quality, and extent of posterior fossa tumors, but offers limited information regarding tumor grade and type. Advanced MRI techniques such as diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) may improve the specific diagnosis of brain tumors in the posterior fossa in children. In this review the conventional neuroimaging findings, as well as the DWI, and DTI characteristics of common pediatric posterior fossa tumors are discussed and summarized.
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Affiliation(s)
- Andrea Poretti
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Martínez León M. Meduloblastoma pediátrico, revisión y puesta al día. RADIOLOGIA 2011; 53:134-45. [DOI: 10.1016/j.rx.2010.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/08/2010] [Accepted: 11/11/2010] [Indexed: 12/28/2022]
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Magnetic resonance imaging spectrum of medulloblastoma. Neuroradiology 2011; 53:387-96. [PMID: 21279509 DOI: 10.1007/s00234-010-0829-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Two medulloblastoma variants were recently added to the WHO classification of CNS tumours. We retrospectively analysed the imaging findings of 37 classic and 27 cases of variant medulloblastomas to identify imaging characteristics that might suggest a particular MB subtype. METHODS Sixty-four patients from three institutions were included. Location, tumour margins, signal intensities on conventional MRI, enhancement pattern, the presence of haemorrhage, calcifications and hydrocephalus were recorded and analysed. Signal characteristics on diffusion-weighted MR images and MR spectra were evaluated when available. RESULTS Thirty-seven classic type of MB (CMB), twelve cases of desmoplastic/nodular medulloblastoma (DMB), nine medulloblastomas with extensive nodularity (MB-EN), five cases of anaplastic and one of large-cell medulloblastoma were included. Fifty of 64 tumours were located in the 4th ventricle region. On T2WI, CMB were all hyperintense, whereas DMB and MB-EN showed isointensity in up to 66%. One third of the classic MB showed only subtle marginal or linear enhancement. All medulloblastoma variants showed marked enhancement. CONCLUSION The results of our study suggest: (a) an age-dependent distribution of MB variants, with DMB and MB-EN more common in younger children; (b) a female predominance in DMB; (c) a more common off-midline location in DMB (50%) and MB-EN (33%) variants.
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