Medulloblastoma with soft-tissue and skeletal metastases in an adult: A case report

Abstract

Abstract. Medulloblastoma (MB) is a highly malignant primary brain tumor, which occurs in the cerebellum or posterior cranial fossa. MB is most commonly identified in children <10 years of age. The disease is rare in adults, affecting patients aged between 30 and 50 years of age, with an incidence of 0.5 cases per 1,000,000 individuals. Extraneural metastases are reported in 7-10% of cases, most commonly involving the bones and more rarely involving the lymph nodes, visceral organs and bone marrow. The current study presents the case of a 36-year-old male who underwent a gross total resection followed by radiation therapy to the craniospinal axis for the treatment of MB. The patient subsequently developed widespread metastasis, which involved the soft tissue of the occipital bone. Subsequently, the patient was administered palliative radiotherapy and initially exhibited a good clinical response. However, the patient succumbed at 18 months post-diagnosis due to dissemination of the disease. The literature on the extraneural metastasis of MB is also reviewed in the current study. IntroductionMedulloblastoma (MB) is the most common primary brain tumor in children; however, the malignancy rarely occurs in adults (1). In total, 7-10% of patients diagnosed with MB develop extraneural metastases, which most commonly involve the bone and lymph nodes, and recently, the frequency of reported extraneural metastases has increased (2-4). The visceral organs are less common sites of extraneural spread in medulloblastoma (5). It is generally believed that the overwhelming majority of cases reported with extraneural metastasis occur in patients who underwent a craniotomy (6). At present, typical treatments for high-risk childhood MB include maximal surgery, craniospinal radiation therapy and adjuvant chemotherapy (7-9). The 2-and 5-year overall survival rates following diagnosis of extraneural metastasis have been reported to be 31 and 26%, respectively (10). In general, the survival rate is considered to be poor. In the current study, the case of a 36-year-old male MB patient with recurrent disease involving the soft tissues of the occipital bone is presented, as well as the subsequent treatment course of the patient. In addition, the extraneural metastasis of MB is discussed. Written informed consent was obtained from the patient for the publication of this case report and any accompanying images. Case reportOn November 15, 2009, a 36-year-old male presented at the Binzhou Medical University Hospital (Binzhou, China) with nausea and vomiting that had persisted for 5 days, but was not accompanied by headache, visual impairment or ataxia. The patient had no significant previous medical history. Cranial magnetic resonance imaging (MRI) revealed the presence of a lesion in the fourth ventricle. Total spinal MRI revealed no evidence of additional central nervous system disease. Subsequently, three days after presentation, the patient underwent a posterior fossa craniotomy with gross total resection of the tumor, in which the cereb...

Recurrent Extraneural Metastatic Medulloblastoma in an Adult Presenting With a Superscan and Treated With Radium-223

“…Extraneural metastasis is an uncommon presentation of recurrent medulloblastoma affecting 5% to 10% of all medulloblastoma cases [1]. Moreover, adult medulloblastoma is extremely rare, with an incidence of 0.6 per million people annually [2,3]. This case report describes the presentation and management of an adult with medulloblastoma who recurred three years after initial treatment with extensive bone-only metastases presenting with a superscan on imaging and treated with radium-223 therapy.…”