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Midline Cerebellar Medulloblastoma in a Seventy-One-Year-Old Patient

Published online by Cambridge University Press:  02 December 2014

Raymund L. Yong*
Affiliation:
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
Eoin C. Kavanagh
Affiliation:
Department of Radiology, University of British Columbia, Vancouver, BC, Canada
David Fenton
Affiliation:
Department of Radiology, University of British Columbia, Vancouver, BC, Canada
Katerina Dorovini-Zis
Affiliation:
Department of Pathology, University of British Columbia, Vancouver, BC, Canada
Manraj K.S. Heran
Affiliation:
Department of Radiology, University of British Columbia, Vancouver, BC, Canada
Charles S. Haw
Affiliation:
Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
*
Division of Neurosurgery, Department of Surgery, University of British Columbia, 3100 - 910 West 10th Avenue, Vancouver, British Columbia, V5Z 4E3, Canada
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Abstract:

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Background:

Medulloblastoma is the most common malignant central nervous system tumour in children but, in contrast, quite rare in adults. Hemispheric, rather than midline, cerebellar medulloblastomas are more common in older children and adults. We present the unusual case of a 71-year-old man who presented with a fourth ventricular mass that proved to be a medulloblastoma.

Methods:

A 71-year-old man presented with progressive balance problems, slurred speech and double vision. A CT scan of the brain revealed a hyperattenuating, partially calcified, avidly enhancing mass within the fourth ventricle. Diffusion weighted MRI showed restricted diffusion within the mass. The patient underwent a midline suboccipital craniotomy and a subtotal resection was achieved.

Results:

Histological examination showed a densely cellular neoplasm composed of small cells with a tendency towards neuroblastic rosette formation. Most cells were strongly positive for neuron-specific enolase and synaptophysin. Ultrastructurally, tumour cells showed evidence of neuronal differentiation. These findings were consistent with a classical medulloblastoma.

Conclusion:

Adult medulloblastoma should be considered in the differential diagnosis of a partially calcified hyperattenuating mass within the fourth ventricle.

Résumé

RÉSUMÉ Contexte:

Le médulloblastome est la tumeur maligne la plus fréquente du système nerveux central chez les enfants. Il est cependant rare chez les adultes. Le médulloblastome cérébelleux hémisphérique plutôt que médian est plus fréquent chez les enfants plus vieux et chez les adultes. Nous présentons un cas rare, celui d'un homme âgé de 71 ans, qui présentait une masse identifiée comme étant un médulloblastome dans le quatrième ventricule.

Méthodes:

Un homme de 71 ans a consulté pour une ataxie, une dysarthrie et une diplopie progressives. La tomodensitométrie cérébrale a montré une masse très atténuante, partiellement calcifiée et très rehaussante, dans le quatrième ventricule. L'IRM de diffusion pondérée a révélé une diffusion restreinte à l'intérieur de la masse. Le patient a subi une craniotomie sous-occipitale médiane et une résection subtotale de la tumeur.

Résultats:

L'examen anatomopathologique a montré qu'il s'agissait d'une néoplasie à haute densité cellulaire composée de petites cellules qui avaient tendance à former des rosettes neuroblastiques. La plupart des cellules tumorales étaient fortement positives pour la neuro specific enolase et la synaptophysine. À la microscopie électronique, les cellules tumorales présentaient des signes de différenciation neuronale. On a posé un diagnostic de médulloblastome classique.

Conclusion:

Le médulloblastome devrait faire partie du diagnostic différentiel d'une masse hyperatténuante, partiellement calcifiée, à l'intérieur du quatrième ventricule chez l'adulte. des patients Asiatiques atteints de SEP étaient semblables à celles des patients de l'Ouest sauf qu'ils avaient de plus grosses lésions à la moelle épinière.

Type
Case Report
Copyright
Copyright © The Canadian Journal of Neurological 2006

References

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