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Tuan HX, Hung ND, Minh ND, Quang NN, Duy NQ, Duc NM. Low apparent diffusion coefficient in an extracranial brain tumor: a case report. J Med Case Rep 2022; 16:310. [PMID: 35982502 PMCID: PMC9389690 DOI: 10.1186/s13256-022-03553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Medulloblastoma is well known as the most common malignant brain tumor identified in children, frequently found at an intra-axial location in the posterior cranial fossa. Extra-axial medulloblastoma is uncommon and often misdiagnosed. We believe that a thorough understanding of atypical medulloblastoma cases is important in daily practice. Case presentation We present the unique case of a 39-year-old woman of Asian descent who suffered from headaches and right-sided hearing impairment. A right extra-axial medulloblastoma with an extremely low apparent diffusion coefficient of 0.404 × 10−3 mm2/second was detected on magnetic resonance imaging. The initial diagnosis suggested schwannoma or hemangioblastoma. However, the postoperative histopathologic findings indicated medulloblastoma (World Health Organization grade IV). Pre- and postoperative magnetic resonance imaging revealed no drop metastasis, but adjuvant radiation therapy was still required as a standard treatment therapy Conclusions Extra-axial medulloblastoma is an uncommon tumor that is often mistaken for other cerebellopontine angle neoplasms. We describe a rare example of extra-axial medulloblastoma, characterized by a low apparent diffusion coefficient. When evaluating an atypical cerebellopontine angle neoplasm, the apparent diffusion coefficient should be considered a relevant indicator.
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Affiliation(s)
- Ho Xuan Tuan
- Department of Medical Imaging, University of Medical Technology and Pharmacy, Da Nang, 500000, Vietnam
| | - Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, 100000, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi, 100000, Vietnam
| | - Nguyen Dinh Minh
- Department of Radiology, Viet Duc Hospital, Hanoi, 100000, Vietnam
| | | | - Ngo Quang Duy
- Department of Radiology, Ha Giang General Hospital, Ha Giang, 200000, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung, Ward 12, District 10, Ho Chi Minh City, 700000, Vietnam.
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2
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Fang FY, Rosenblum JS, Ho WS, Heiss JD. New Developments in the Pathogenesis, Therapeutic Targeting, and Treatment of Pediatric Medulloblastoma. Cancers (Basel) 2022; 14:cancers14092285. [PMID: 35565414 PMCID: PMC9100249 DOI: 10.3390/cancers14092285] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 01/25/2023] Open
Abstract
Pediatric medulloblastoma (MB) is the most common pediatric brain tumor with varying prognoses depending on the distinct molecular subtype. The four consensus subgroups are WNT, Sonic hedgehog (SHH), Group 3, and Group 4, which underpin the current 2021 WHO classification of MB. While the field of knowledge for treating this disease has significantly advanced over the past decade, a deeper understanding is still required to improve the clinical outcomes for pediatric patients, who are often vulnerable in ways that adult patients are not. Here, we discuss how recent insights into the pathogenesis of pediatric medulloblastoma have directed current and future research. This review highlights new developments in understanding the four molecular subtypes’ pathophysiology, epigenetics, and therapeutic targeting. In addition, we provide a focused discussion of recent developments in imaging, and in the surgery, chemotherapy, and radiotherapy of pediatric medulloblastoma. The article includes a brief explanation of healthcare costs associated with medulloblastoma treatment.
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Affiliation(s)
- Francia Y. Fang
- Department of Orthopedics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Jared S. Rosenblum
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Winson S. Ho
- Department of Neurosurgery, The University of Texas at Austin, Austin, TX 78712, USA;
| | - John D. Heiss
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
- Correspondence:
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3
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Prabhu S, Agarwal S, Prabhu S, Prabhu A. Extra-Axial Cerebello-Pontine Angle Medulloblastoma in an Infant: A Rare Case Report with Review of Literature. Asian J Neurosurg 2021; 16:447-451. [PMID: 34660353 PMCID: PMC8477824 DOI: 10.4103/ajns.ajns_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 11/24/2022] Open
Abstract
Medulloblastoma is a fairly common neoplastic growth seen majorly in children, presenting as an intra-axial midline mass arising from the cerebellar vermis. However, its presentation as an extra-axial mass in the cerebellopontine angle (CPA) is extremely rare, such that, only 39 cases have been reported in the world literature till 2016. Only one case has ever been reported of an extra-axial CPA medulloblastoma in an infant; who was aged 1 year. We present a case report of an 8-month-old infant, with an extra-axial CPA medulloblastoma and discuss its management strategy.
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Affiliation(s)
- Santosh Prabhu
- Department of Neurosurgery, Western India Institute of Neurosciences, Kolhapur, Maharashtra, India
| | - Sidharth Agarwal
- Department of Neurosurgery, Western India Institute of Neurosciences, Kolhapur, Maharashtra, India
| | - Sujata Prabhu
- Department of Neurosurgery, Western India Institute of Neurosciences, Kolhapur, Maharashtra, India
| | - Akash Prabhu
- Department of Neurosurgery, Western India Institute of Neurosciences, Kolhapur, Maharashtra, India
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4
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Al-Sharydah AM, Al-Abdulwahhab AH, Al-Suhibani SS, Al-Issawi WM, Al-Zahrani F, Katbi FA, Al-Thuneyyan MA, Jallul T, Mishaal Alabbas F. Posterior fossa extra-axial variations of medulloblastoma: a pictorial review as a primer for radiologists. Insights Imaging 2021; 12:43. [PMID: 33822292 PMCID: PMC8024434 DOI: 10.1186/s13244-021-00981-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
Manifestations of an atypical variant of medulloblastoma of the posterior fossa in extra-axial locations have been reported, and key questions concerning its interpretation have been raised previously. This review illustrated the clinico-radiological and histopathological features of the posterior fossa extra-axial medulloblastoma and described possible management strategies. We thoroughly reviewed all atypical anatomical locations of medulloblastoma reported within the posterior fossa and extra-axial spaces. The main characteristics of diagnostic imaging and histopathological results, primarily the distinctive radiopathological characteristics, were summarized to distinguish between intra- and extra-axial medulloblastoma, or pathologies mimicking this tumor. Most cases of posterior fossa extra-axial medulloblastoma have been reported in the cerebellopontine angle, followed by the tentorial and lateral cerebellar locations. The dural tail sign, which is commonly observed in meningioma, is rarely seen in intra- or extra-axial medulloblastoma and might be associated with other benign or malignant lesions. In addition to magnetic resonance imaging, the proposed new imaging techniques, including advances in modern neuroimaging modalities, were discussed, as potentially efficient modalities for characterizing extra-axial medulloblastoma. Radionuclide imaging and magnetic resonance perfusion imaging are practical alternatives to limit the number of differential diagnoses. We believe that medulloblastoma cases are likely under-reported because of publication bias and frequent tumors in unusual locations. Addressing these issues would help establish a more accurate understanding of this entity.
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Affiliation(s)
- Abdulaziz M Al-Sharydah
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, AlKhobar City, Eastern Province, Saudi Arabia
| | - Abdulrahman Hamad Al-Abdulwahhab
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, AlKhobar City, Eastern Province, Saudi Arabia.
| | - Sari Saleh Al-Suhibani
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, AlKhobar City, Eastern Province, Saudi Arabia
| | - Wisam M Al-Issawi
- Neurosurgery Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, AlKhobar City, Eastern Province, Saudi Arabia
| | - Faisal Al-Zahrani
- Radiodiagnostics and Medical Imaging Department, King Fahd Military Medical Complex, Dhahran City, Eastern Province, Saudi Arabia
| | - Faisal Ahmad Katbi
- Emergency Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Alkhobar City, Eastern Province, Saudi Arabia
| | - Moath Abdullah Al-Thuneyyan
- Diagnostic and Interventional Radiology Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, AlKhobar City, Eastern Province, Saudi Arabia
| | - Tarek Jallul
- Neurosurgery Department, King Fahd Specialist Hospital, Dammam City, Eastern Province, Saudi Arabia
| | - Faisal Mishaal Alabbas
- Neurosurgery Department, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, AlKhobar City, Eastern Province, Saudi Arabia
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Thanh Dung L, Minh Duc N. Medulloblastoma in the cerebellopontine angle mimicking a schwannoma. Clin Case Rep 2021; 9:1948-1953. [PMID: 33936621 PMCID: PMC8077292 DOI: 10.1002/ccr3.3912] [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] [Received: 11/25/2020] [Accepted: 01/23/2021] [Indexed: 02/05/2023] Open
Abstract
The typical distinction between cerebellopontine angle (CPA) medulloblastoma and other primary CPA tumors was not fully known. While CPA medulloblastoma is very uncommon, it should be included in the differential diagnosis of patients with CPA tumors.
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Affiliation(s)
- Le Thanh Dung
- Department of RadiologyViet Duc HospitalHa NoiVietnam
- Department of RadiologyHanoi Medical UniversityHa NoiVietnam
| | - Nguyen Minh Duc
- Department of RadiologyHanoi Medical UniversityHa NoiVietnam
- Department of RadiologyPham Ngoc Thach University of MedicineHo Chi Minh CityVietnam
- Department of RadiologyChildren's Hospital 2Ho Chi Minh CityVietnam
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6
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Singh SK, Kumar N. Extraaxial Cerebellopontine Angle Medulloblastoma with Multiple Intracranial Metastases in Adult: A Rare Case Report with a Review of Literature. Asian J Neurosurg 2020; 15:695-698. [PMID: 33145231 PMCID: PMC7591221 DOI: 10.4103/ajns.ajns_120_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/23/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022] Open
Abstract
Medulloblastoma (MB) is very rare malignant primary brain tumor in adults and its location at cerebellopontine angle (CPA) is even rarer. There are only few case reports of CPA MBs in literature. Most of them are reported in pediatric age groups which are mostly intraaxial. Only 11 cases of extra-axial CPA MBs have been reported so far. The author is reporting a very rare case of adult extra-axial CPA MBs with multiple intracranial metastases. We are also reviewing clinical and radiological features and unusual way of its presentation along with surgical management. Keeping MBs as one of the differential diagnosis for extra-axial CPA tumors is going to increase our spectrum of diagnosis which can lead to alteration in management.
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Affiliation(s)
| | - Niraj Kumar
- Department of Neurology, AIIMS Rishikesh, Uttarakhand, India
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The clinical treatment and outcome of cerebellopontine angle medulloblastoma: a retrospective study of 15 cases. Sci Rep 2020; 10:9769. [PMID: 32555264 PMCID: PMC7300107 DOI: 10.1038/s41598-020-66585-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/18/2020] [Indexed: 02/02/2023] Open
Abstract
Medulloblastoma (MB) is the most common malignant pediatric brain tumor arising in the cerebellum or the 4th ventricle. Cerebellopontine angle (CPA) MBs are extremely rare tumors, with few cases previously described. In this study, we sought to describe the clinical characteristics, molecular features and outcomes of CPA MB. We retrospectively reviewed a total of 968 patients who had a histopathological diagnosis of MB at the Beijing Neurosurgical Institute between 2002 and 2016. The demographic characteristics, clinical manifestations and radiological features were retrospectively analyzed. Molecular subgroup was evaluated by the expression profiling array or immunohistochemistry. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier analysis. In this study, 15 patients (12 adults and 3 children) with a mean age at diagnosis of 25.1 years (range 4–45 years) were included. CPA MBs represented 1.5% of the total cases of MB (15/968). Two molecular subgroups were identified in CPA MBs: 5 WNT-MBs (33%) and 10 SHH-MBs (67%). CPA WNT-MBs had the extracerebellar growth with the involvement of brainstem (P = 0.002), whereas CPA SHH-MBs predominantly located within the cerebellar hemispheres (P = 0.004). The 5-year OS and PFS rates for CPA MB were 80.0% ± 10.3% and 66.7% ± 12.2%, respectively. Pediatric patients with CPA MBs had worse outcomes than adult patients (OS: P = 0.019, PFS: P = 0.078). In conclusion, CPA MB is extremely rare and consists of two subgroups. Adult patients with CPA MB had a good prognosis. Maximum safe surgical resection combined with adjuvant radiotherapy and chemotherapy can be an effective treatment strategy for this rare tumor.
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Alharbi M, Mobark N, Bashawri Y, Abu Safieh L, Alowayn A, Aljelaify R, AlSaeed M, Almutairi A, Alqubaishi F, AlSolme E, Ahmad M, Al-Banyan A, Alotabi FE, Serrano J, Snuderl M, Al-Rashed M, Abedalthagafi M. Methylation Profiling of Medulloblastoma in a Clinical Setting Permits Sub-classification and Reveals New Outcome Predictions. Front Neurol 2020; 11:167. [PMID: 32265819 PMCID: PMC7100767 DOI: 10.3389/fneur.2020.00167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/21/2020] [Indexed: 12/11/2022] Open
Abstract
Medulloblastoma (MB) is the most common childhood malignant brain tumor and is a leading cause of cancer-related death in children. DNA methylation profiling has rapidly advanced our understanding of MB pathogenesis at the molecular level, but assessments in Saudi Arabian (SA)-MB cases are sparse. MBs can be sub-grouped according to methylation patterns from FPPE samples into Wingless (WNT-MB), Sonic Hedgehog (SHH-MB), Group 3 (G3), and Group 4 (G4) tumors. The WNT-MB and SHH-MB subgroups are characterized by gain-of function mutations that activate oncogenic cell signaling, whilst G3/G4 tumors show recurrent chromosomal alterations. Given that each subgroup has distinct clinical outcomes, the ability to subgroup SA-FPPE samples holds significant prognostic and therapeutic value. Here, we performed the first assessment of MB-DNA methylation patterns in an SA cohort using archival biopsy material (FPPE n = 49). Of the 41 materials available for methylation assessments, 39 could be classified into the major DNA methylation subgroups (SHH, WNT, G3, and G4). Furthermore, methylation analysis was able to reclassify tumors that could not be sub-grouped through next-generation sequencing, highlighting its superior accuracy for MB molecular classifications. Independent assessments demonstrated known clinical relationships of the subgroups, exemplified by the high survival rates observed for WNT tumors. Surprisingly, the G4 subgroup did not conform to previously identified phenotypes, with a high prevalence in females, high metastatic rates, and a large number of tumor-associated deaths. Taking our results together, we demonstrate that DNA methylation profiling enables the robust sub-classification of four disease sub-groups in archival FFPE biopsy material from SA-MB patients. Moreover, we show that the incorporation of DNA methylation biomarkers can significantly improve current disease-risk stratification schemes, particularly concerning the identification of aggressive G4 tumors. These findings have important implications for future clinical disease management in MB cases across the Arab world.
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Affiliation(s)
- Musa Alharbi
- Department of Paediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nahla Mobark
- Department of Paediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Yara Bashawri
- Department of Biostatistics, Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Leen Abu Safieh
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Albandary Alowayn
- Department of Biostatistics, Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Rasha Aljelaify
- Department of Biostatistics, Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mariam AlSaeed
- Department of Biostatistics, Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amal Almutairi
- Department of Biostatistics, Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fatimah Alqubaishi
- Department of Biostatistics, Research Centre, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ebtehal AlSolme
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Maqsood Ahmad
- Department of Neuroscience, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ayman Al-Banyan
- Department of Neuroscience, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahad E Alotabi
- Department of Neuroscience, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Jonathan Serrano
- Department of Pathology, NYU Langone Medical Center, New York, NY, United States
| | - Matija Snuderl
- Department of Pathology, NYU Langone Medical Center, New York, NY, United States
| | - May Al-Rashed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
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Tomomasa R, Nakata S, Nobusawa S, Horiguchi K, Matsumura N, Ikota H, Hirato J, Yoshimoto Y, Yokoo H. Primary diffuse leptomeningeal atypical teratoid/rhabdoid tumor diagnosed by cerebrospinal fluid cytology: case report with molecular genetic analysis. Hum Pathol 2018; 77:116-120. [DOI: 10.1016/j.humpath.2017.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/21/2017] [Accepted: 12/27/2017] [Indexed: 11/28/2022]
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10
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Presutto E, Chappell M, Fullmer J, Ezhapilli S. Posterior fossa medulloblastoma in an atypical extra-axial location: A case report. Radiol Case Rep 2018; 13:365-370. [PMID: 29904474 PMCID: PMC5999935 DOI: 10.1016/j.radcr.2018.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/04/2018] [Indexed: 12/12/2022] Open
Abstract
Medulloblastoma is the most common posterior fossa tumor of childhood typically within the fourth ventricle. However, extra-axial medulloblastoma in posterior fossa is an uncommon diagnosis. We report a case in a 33-month-old male who presented with repeated complaints of abdominal pain, intermittent emesis, and diarrhea, and diagnosed with right cerebellar extra-axial medulloblastoma, which was surgically resected. Majority of the reported extra-axial medulloblastoma in posterior fossa in the United States are located in the cerebellopontine angle. However, to the best of our knowledge, our case is the first to document medulloblastoma occurring exclusively in the cerebellar hemispheric extra-axial space rather than the cerebellopontine angle. Although the diagnosis can present as a radiological dilemma, a systematic multimodality imaging approach can aid in narrowing the differential diagnosis and timely management. In this case report, we will discuss the imaging characteristics, differential diagnosis, and management strategies, alongside a brief review of the world literature of extra-axial medulloblastoma.
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Affiliation(s)
- Elizabeth Presutto
- SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Matthew Chappell
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Joseph Fullmer
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | - Sajeev Ezhapilli
- Department of Radiology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
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