46‐year‐old Man With a Spinal Cord Mass

Abstract

Medulloblastoma accounts for only 1% of all adult CNS tumors. Likewise, recurrence of adult medulloblastoma greater than 20 years after initial diagnosis is extremely rare.We describe a case of adult medulloblastoma with late relapse of disease. The patient was 24 years old when first diagnosed and was treated with total tumor resection and craniospinal radiation. At the age of 45, an enhancing 1.3 cm intradural extramedullary spinal cord lesion at T5 was discovered on MRI. This was presumed to be recurrent medulloblastoma in the form of drop metastasis and the patient was treated with spinal radiation. Several months following treatment, at the age of 46, a follow-up MRI demonstrated an enhancing 1.4 cm intradural extramedullary spinal cord lesion at T7. The lesion was resected and histopathologic examination was most consistent with medulloblastoma, late drop metastasis. Although rare, adult medulloblastoma recurring 20 years after initial diagnosis should always be considered in the main differential diagnosis when working up CNS lesions at or outside the primary tumor site.

Isolated Supratentorial Intraventricular Recurrence of Medulloblastoma

“…Medulloblastoma, a malignant tumor typically arising from the cerebellar vermis in young children and lobes in older children, represents 4–8% of all intracranial tumors, and is the most common malignant central nervous system tumor of childhood 19 20 21) , with approximately 80% occurring in patients under 15 years of age 21) . It accounts for 15–25% of all childhood brain tumors in comparison with only 1% of adult intracranial neoplasms, with a slight male predominance in both groups 19 20 21 23 24) .…”

“…Medulloblastoma (MB) is the most common malignant tumor in children, accounting for 15 to 25% of all childhood brain tumors 19 20 21) . Occurrence in the adult population is also well documented, but only accounts for 1% of adult tumors 11) .…”

“…Time to recurrence typically occurs within two years of initial diagnosis in the pediatric population. Tumors that follow Collin's Law (tumor free period of 9 months plus the age at diagnosis) are considered to be cured 1 19 20) . However, late recurrence of MB has been documented in the pediatric population 2 3 12 13 23) .…”

Medulloblastoma: Intraventricular Recurrences

“…7 Homer-Wright rosettes may be seen. [9] Adults are more likely to have laterally-located tumors, which more often desmoplastic. [9] Both tumor types include markers of neuronal lineage, such as class III beta tubulin and MAP-2 neurofilaments, whereas more adult tumors will express GFAP.…”

“…[9] Adults are more likely to have laterally-located tumors, which more often desmoplastic. [9] Both tumor types include markers of neuronal lineage, such as class III beta tubulin and MAP-2 neurofilaments, whereas more adult tumors will express GFAP. [10] The anaplastic/large cell variant is more frequently seen in older children and adults.…”