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Borni M, Abdelmouleh S, Cherif I, Daoud H, Boudawara MZ. Pediatric synchronous multifocal and disseminated cerebrospinal classic medulloblastoma revealed by bilateral decreased visual acuity: a case report. Childs Nerv Syst 2022; 38:2211-2215. [PMID: 35590112 DOI: 10.1007/s00381-022-05546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
Medulloblastoma (MB) is a rapidly growing malignant solid tumor that arises from stem cells located in the subependymal germinal matrix or outer granular layer of the cerebellum. It represents 15 to 30% of pediatric brain tumors and less than 1% of primary brain tumors. The reason for the high incidence of MB in children compared to adults is the embryonic origin of the tumor. In typical cases, MB manifests as a solitary lesion in the fourth ventricle or in the cerebellar parenchyma; cases of synchronous multifocal and disseminated MB are quite rare in patients without familial tumor syndromes. To date, only 7 cases in adults and a single pediatric case with Gorlin syndrome have been described previously. Here, the authors report a new case of synchronous multifocal classic cerebrospinal histologically confirmed MB in a 10-year-old male patient revealed by bilateral decreased visual acuity without any other localizing neurological signs. The authors will proceed with a review of the current literature regarding this rare entity.
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Affiliation(s)
- Mehdi Borni
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia.
| | | | - Ines Cherif
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
| | - Hatem Daoud
- Department of Neurosurgery, UHC Habib Bourguiba, Sfax, Tunisia
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Troncon I, Guerriero A, Rossi S, Ronzon M, Padovan M, Mario C, Zanatta L, Toffolatti L, Marton E, Lombardi G, Dei Tos AP, Canova G. Multifocal Medulloblastoma in an Adult Patient: Description of a Rare Presentation and Review of the Literature. Case Rep Pathol 2020; 2020:4502878. [PMID: 33005468 PMCID: PMC7503105 DOI: 10.1155/2020/4502878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/20/2023] Open
Abstract
Medulloblastoma is an embryonal neuroepithelial tumor that affects mainly childhood and more rarely adults. Medulloblastoma occurring as multiple nodules at diagnosis is a rare and tricky presentation. Here, we describe the case of a previously healthy 47-year-old woman with multiple posterior fossa cerebellar tumors. Histological, immunohistochemical, and molecular analyses were performed to best characterize the two excised lesions. The histopathological analysis revealed different variants of medulloblastoma in the excised nodules, one being extensive nodularity, rare in adults, and the other desmoplastic/nodular with areas of anaplasia. Immunostains and molecular analysis classified both nodules as SHH medulloblastoma. Adult medulloblastoma is extremely rare. Important differences exist between adult medulloblastoma and medulloblastoma arising in children and infants. Such differences are in location, distribution of histological variants and of molecular subgroups, survival rates, and therapeutic options. An extensive morphological and molecular characterization of such rare tumors is necessary to choice the best-tailored therapy.
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Affiliation(s)
- Irene Troncon
- Department of Neurosurgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Angela Guerriero
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Sabrina Rossi
- Department of Pathology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Monica Ronzon
- Department of Neuroradiology, Treviso Regional Hospital, Treviso, Italy
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Caccese Mario
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Lucia Zanatta
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Luisa Toffolatti
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
| | - Elisabetta Marton
- Department of Neurologic Surgery, Treviso Regional Hospital, Treviso, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Angelo Paolo Dei Tos
- Department of Pathology and Molecular Genetics, Treviso General Hospital, Treviso, Italy
- Department of Medicine, University of Padova School of Medicine, Padova, Italy
| | - Giuseppe Canova
- Department of Neurologic Surgery, Treviso Regional Hospital, Treviso, Italy
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Cuccia F, Mortellaro G, Ognibene L, Craparo G, Lo Casto A, Ferrera G. Salvage Re-irradiation Options in Adult Medulloblastoma: A Case Report and Review of the Literature. In Vivo 2020; 34:1283-1288. [PMID: 32354920 DOI: 10.21873/invivo.11903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM Medulloblastoma is a rare tumor of adult age, while it occurs more frequently in children. Given the rarity, there is a lack of evidence for the treatment of recurrent disease. Few data are available about salvage re-irradiation collecting very heterogeneous series. CASE REPORT A 51-year-old male presented with headache, nausea, double vision, and gait disorders. A contrast-enhanced brain-MRI showed the presence of multifocal medulloblastoma. After surgery, adjuvant craniospinal radiotherapy was performed, chemotherapy was stopped due to toxicity. After 27 months, a new MRI and a Methionine-PET revealed a late pontocerebellar relapse; multidisciplinary board decided for a SBRT treatment. The second course of RT was well tolerated and 14 months later, the patient is alive in good general conditions, with no evidence of disease. CONCLUSION Our experience supports the use of salvage stereotactic radiotherapy as a safe and effective treatment option.
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Affiliation(s)
- Francesco Cuccia
- Radiation Oncology School, University of Palermo, Palermo, Italy .,Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | | | - Lucia Ognibene
- Radiotherapy Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy
| | | | - Antonio Lo Casto
- Radiation Oncology School, University of Palermo - Section of Radiology - Di.Bi.Med., Palermo, Italy
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Yue H, Ling W, Yibo O, Sheng W, Sicheng T, Jincao C, Dongsheng G. Subfrontal recurrence after cerebellar medulloblastoma resection without local relapse: case-based update. Childs Nerv Syst 2018; 34:1619-1626. [PMID: 29934705 DOI: 10.1007/s00381-018-3869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/14/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This report detailed four cases of tumor recurrence in the subfrontal region after cerebellar medulloblastoma resection without local relapse and explored the causes of recurrence. In addition, a case-based update and insight into the entity is attempted. METHODS All four patients received cerebellar medulloblastoma resection and postoperative radiotherapy. They were admitted to our hospital when they were found to have a recurrent tumor in the subfrontal region of the anterior skull base. All four patients received re-resection of the tumor, which was confirmed to be recurrent medulloblastoma by postoperative pathological results. RESULTS All patients received local radiotherapy and temozolomide chemotherapy after recurrent tumor resection. They all died due to multiple organ failure resulting from tumor metastasis to other sites or tumor regrowth within 2 years after the second operation. CONCLUSION Medulloblastoma metastasize to the subfrontal region and develop a homogenous recurrence is rare. Underdosage of radiation, a gravity-related sanctuary effect, surgical position, and perioperative hydrocephalus management might be factors contributing to this supratentorial meningeal recurrence. A better prevention of tumor recurrence might be achieved by extensive microsurgical tumor resection in the initial operation and by minimizing the need for a permanent V-P shunt in the treatment of perioperative hydrocephalus as well as by administering full-dose radiotherapy to the region of the cribriform plate in the subfrontal area.
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Affiliation(s)
- He Yue
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wang Ling
- Department of Operating room, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Ou Yibo
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Wang Sheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Tang Sicheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chen Jincao
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, 430071, People's Republic of China
| | - Guo Dongsheng
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
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