J Korean Neurosurg Soc.  2015 Dec;58(6):557-559. 10.3340/jkns.2015.58.6.557.

Isolated Supratentorial Intraventricular Recurrence of Medulloblastoma

• Abode-Iyamah KO
• Winslow N
• Flouty O
• Kirby P

• KMID: 2151160
• DOI: http://doi.org/10.3340/jkns.2015.58.6.557

Abstract

Medulloblastoma is a common pediatric tumor typically diagnosed before the age of fifteen. Initial therapy includes surgical resection and radiation of the entire neuro-axis. Recurrence is common and typically occurs within 2 years of initial diagnosis. Those fitting Collin's Law is considered tumor-free. We report a case of single supratentorial recurrence 13 years after initial diagnosis. Here we present a 22 year old male presenting 13 years after initial diagnosis with isolated septum pellucidum recurrence. He underwent complete resection of the tumor. Medulloblastoma is a common in the pediatric population. Late recurrence to the ventricular system is uncommon. Long term follow-up is recommended in these patients.

Keyword

Medulloblastoma; PNET; Recurrence; Hydrocephalus, Drop metastasis

MeSH Terms

Diagnosis
Follow-Up Studies
Humans
Jurisprudence
Male
Medulloblastoma*
Neuroectodermal Tumors, Primitive
Recurrence*
Septum Pellucidum

Figure

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  Fig. 1 CT brain without contrast (B) showing a septal lesion causing obstruction of the foramen Monro resulting in obstructive hydrocephalus. (A) MRI of the brain without contrast on 7/14/2009 last scan prior to recent presentation.

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  Fig. 2 MRI with contrast axial (A), sagittal (B), and coronal (C) showing a homogenously enhancing septal mass obstructing the foramen Monro.

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  Fig. 3 MRI with contrast axial (A), sagittal (B), and coronal (C) showing right transcortical intraventricular approach for tumor resection. Gross tumor resection was accomplished.

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  Fig. 4 A : Diffuse infiltrate of small to large pleomorphic cells with little cytoplasm (synaptophysin positive). B : High power view. Cells have hyperchromatic angular nuclei. Cell wrapping, a feature commonly found in anaplastic/large cell MB (white arrow).

Reference

1. Allan R, Gill A, Spittaler P. Recurrent medulloblastoma--violation of Collin's law by 14 years. J Clin Neurosci. 2004; 11:756–757. PMID: 15337141.

2. Amagasaki K, Yamazaki H, Koizumi H, Hashizume K, Sasaguchi N. Recurrence of medulloblastoma 19 years after the initial diagnosis. Childs Nerv Syst. 1999; 15:482–485. PMID: 10502011.

3. Belza MG, Donaldson SS, Steinberg GK, Cox RS, Cogen PH. Medulloblastoma : freedom from relapse longer than 8 years--a therapeutic cure? J Neurosurg. 1991; 75:575–582. PMID: 1885975.

4. Brown WD, Tavaré CJ, Sobel EL, Gilles FH. Medulloblastoma and Collins' law : a critical review of the concept of a period of risk for tumor recurrence and patient survival. Neurosurgery. 1995; 36:691–697. PMID: 7596498.

5. Buglione M, Triggiani L, Grisanti S, Liserre R, Buttolo L, Gipponi S, et al. Retreatment of recurrent adult medulloblastoma with radiotherapy : a case report and review of the literature. J Med Case Rep. 2013; 7:64. PMID: 23497715.

6. Cieślak E, Kepka L, Fijuth J, Marchel A, Kroh H. Very late relapse of medulloblastoma. Folia Neuropathol. 2004; 42:49–53. PMID: 15119746.

7. David KM, Casey AT, Hayward RD, Harkness WF, Phipps K, Wade AM. Medulloblastoma : is the 5-year survival rate improving? A review of 80 cases from a single institution. J Neurosurg. 1997; 86:13–21. PMID: 8988076.

8. Ferrante L, Mastronardi L, Celli P, Acqui M, Cervoni L, Fortuna A. Medulloblastoma in adulthood. J Neurosurg Sci. 1991; 35:23–30. PMID: 1890457.

9. Friedberg MH, David O, Adelman LS, Heilman CB. Recurrence of medulloblastoma : violation of Collins' law after two decades. Surg Neurol. 1997; 47:571–574. PMID: 9167782.

10. Giordana MT, Cavalla P, Dutto A, Borsotti L, Chiò A, Schiffer D. Is medulloblastoma the same tumor in children and adults? J Neurooncol. 1997; 35:169–176. PMID: 9266455.

11. Giordana MT, Schiffer P, Lanotte M, Girardi P, Chio A. Epidemiology of adult medulloblastoma. Int J Cancer. 1999; 80:689–692. PMID: 10048968.

12. Hardy DG, Hope-Stone HF, McKenzie CG, Scholtz CL. Recurrence of medulloblastoma after homogeneous field radiotherapy. Report of three cases. J Neurosurg. 1978; 49:434–440. PMID: 682006.

13. King GA, Sagerman RH. Late recurrence in medulloblastoma. Am J Roentgenol Radium Ther Nucl Med. 1975; 123:7–12.

14. Massimino M, Antonelli M, Gandola L, Miceli R, Pollo B, Biassoni V, et al. Histological variants of medulloblastoma are the most powerful clinical prognostic indicators. Pediatr Blood Cancer. 2013; 60:210–216. PMID: 22693015.

15. Massimino M, Casanova M, Polastri D, Biassoni V, Modena P, Pecori E, et al. Relapse in medulloblastoma : what can be done after abandoning high-dose chemotherapy? A mono-institutional experience. Childs Nerv Syst. 2013; [Epub ahead of print].

16. Miralbell R, Bleher A, Huguenin P, Ries G, Kann R, Mirimanoff RO, et al. Pediatric medulloblastoma : radiation treatment technique and patterns of failure. Int J Radiat Oncol Biol Phys. 1997; 37:523–529. PMID: 9112448.

17. Nigri F, Telles C, Acioly MA. Late obstruction of an endoscopic third ventriculostomy stoma by metastatic seeding of a recurrent medulloblastoma. J Neurosurg Pediatr. 2010; 5:641–644. PMID: 20515341.

18. Nishio S, Morioka T, Takeshita I, Fukui M. Medulloblastoma : survival and late recurrence after the Collins' risk period. Neurosurg Rev. 1997; 20:245–249. PMID: 9457719.

19. Roka YB, Bista P, Sharma GR, Adhikari D, Kumar P. Frontal recurrence of medulloblastoma five years after excision and craniospinal irradiation. Indian J Pathol Microbiol. 2009; 52:383–385. PMID: 19679968.

20. Sanders MA, Vitaz T, Rosenblum M, Plaga AR, Parker JC Jr, Parker JR. 46-year-old man with a spinal cord mass. Brain Pathol. 2011; 21:109–112. PMID: 21129065.

21. Sarkar C, Pramanik P, Karak AK, Mukhopadhyay P, Sharma MC, Singh VP, et al. Are childhood and adult medulloblastomas different? A comparative study of clinicopathological features, proliferation index and apoptotic index. J Neurooncol. 2002; 59:49–61. PMID: 12222838.

22. Stevens B, Razzaqi F, Yu L, Craver R. Late recurrence of medulloblastoma. J La State Med Soc. 2008; 160:138–141. PMID: 18655650.

23. Sun LM, Yeh SA, Wang CJ, Huang EY, Chen HC, Hsu HC, et al. Postoperative radiation therapy for medulloblastoma--high recurrence rate in the subfrontal region. J Neurooncol. 2002; 58:77–85. PMID: 12160144.

24. Tabori U, Sung L, Hukin J, Laperriere N, Crooks B, Carret AS, et al. Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma. Int J Radiat Oncol Biol Phys. 2006; 64:402–407. PMID: 16198067.