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| LETTER TO EDITOR |
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| Year : 2020 | Volume
: 3
| Issue : 4 | Page : 136-137 |
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Bilateral medulloblastoma
Varun Aggarwal1, Amit Narang1, Chandani Maheshwari2, Paramdeep Singh3
1 Department of Neurosurgery, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
2 Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
3 Department of Radiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
| Date of Submission | 08-Jul-2020 |
| Date of Decision | 09-Jul-2020 |
| Date of Acceptance | 17-Jul-2020 |
| Date of Web Publication | 24-Dec-2020 |
Correspondence Address:
Dr. Paramdeep Singh
Department of Radiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/VIT.VIT_23_20
How to cite this article:
Aggarwal V, Narang A, Maheshwari C, Singh P. Bilateral medulloblastoma. Vasc Invest Ther 2020;3:136-7 |
Dear Editor,
We present a case of 18-year-old male with a history of headache, gait unsteadiness, and tremors since 1 month. On examination, the patient had a bilateral cerebellar sign, i.e., dysdiadochokinesia and tremors. Magnetic resonance imaging (MRI) revealed a bilateral cerebellar lesion involving the tentorial surface with obstructive hydrocephalus. The lesion was hypointense on T1-weighted image and hyperintense on T2-weighted image. There was no diffusion restriction. In contrast, T1-weighted image lesion was heterogeneously enhancing [Figure 1]. A provisional diagnosis of cerebellar glioma, solid pilocytic astrocytoma, and medulloblastoma was made. The patient underwent midline suboccipital craniotomy with C1 arch excision. The brain was bulging at the time of opening the dura. An external ventricular drain was placed in the right Frazier point. The brain was lax after drainage of 40 ml of cerebrospinal fluid (CSF). The tumor was grayish, soft, suckable, highly vascular, and having a poor plane with the surrounding tissue. The tumor was decompressed in a piecemeal manner. Near-total decompression was done. The dura was closed with pericranial fascia. The patient was discharged on the 6th postoperative day. Histopathology revealed blue cell tumor, i.e., medulloblastoma. Postoperatively, the patient was symptomatically improved and planned for adjuvant therapy. | Figure 1: Magnetic resonance imaging images showing enhancing bilateral cerebellar lesion along the tentorial surface causing obstructive hydrocephalous
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Medulloblastoma is a primitive neuroectodermal tumor. It most commonly affects children which may also affect adults. It accounts for approximately 20% of all primary central nervous system tumors of childhood and 1% of adult brain tumors.[1] The World Health Organization classification of medulloblastoma is as follows: classic, desmoplastic, extensive nodular, and large cell/anaplastic. These tumors are further molecularly classified into Sonic Hedgehog (SHH), WNT, Group 3, and Group 4. SHH subgroup MB comprises two-third of cases in adults.[2] These are predominantly located mostly in the midline vermis in children and cerebellar hemisphere tumors in adults. Medulloblastomas are known to spread by CSF pathways. McFarland noted that metastatic nodules caused by CSF seeding occurred mainly in the spinal canal due to the predominantly downward flow of CSF from the cisterna magna.[3] Treatment options include complete total surgical resection plus craniospinal irradiation. Chemotherapy is another treatment modality, though its effectiveness in the management of medulloblastoma is still controversial. Subtotal surgical resection and evidence of disease dissemination are considered poor prognostic factors.[4] Five-year survival for medulloblastoma in adults has been estimated to be 46%–78% as per the reports by Skołyszewski andGliński.[5] Bilateral medulloblastomas arising separately from both the cerebellar hemispheres are very rare. There are four cases of bilateral medulloblastoma mentioned in the literature.[6],[7],[8] The treatment strategy for these patients should be the same as in routine medulloblastoma cases, which includes postoperative craniospinal irradiation. Whether the prognosis of these patients is any different from the routine medulloblastoma patients is not clear.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Mazzola CA, Pollack IF. Medulloblastoma. Curr TreatOptions Neurol. 2003; 5: 189-98.  |
| 2. | Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of tumors of the central nervous system: A summary. Acta Neuropathol 2016;131:803-20. |
| 3. | McFarland DR, Horwitz H, Saenger EL, Bahr GK. Medulloblastoma – A review of prognosis and survival. Br J Radiol 1969;42:198-214. |
| 4. | Le QT, Weil MD, Wara WM, Lamborn KR, Prados MD, Edwards MS, et al. Adult medulloblastoma: An analysis of survival and prognostic factors. Cancer J Sci Am 1997;3:238-45. |
| 5. | Skołyszewski J, Gliński B. Results of postoperative irradiation of medulloblastoma in adults. Int J Radiat Oncol Biol Phys 1989;16:479-82. |
| 6. | Velho V, Palande D, Kakani A, Mally R, Ghodgaonkar P, Jaiswal A. Bilateral cerebellar medulloblastomas: A case report and review of literature. Internet J Neurosurg 2007;5:2-4. |
| 7. | Cabrera C, Martin F, Ricardo PM, Mantilla M, Isabel M. Bilateral cerebellar medulloblastoma in adults: Report of two cases. Rev Colombiana Radiol 2011;22:3362-6. |
| 8. | Malheiros SM, Carrete H Jr., Stávale JN, Santos AJ, Borges LR, Guimarães IF, et al. MRI of medulloblastoma in adults. Neuroradiology 2003;45:463-7. |
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