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Left cerebellar hemisphere mass, very heterogeneous with cystic areas and only minimal enhancement of the solid component, has strikingly low ADC values (measured at 450 x 10-6 mm2/s) consistent with a highly cellular tumour. Medulloblastoma is by far the most likely diagnosis.
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The patient went on to have a craniotomy and histology confirmed the diagnosis of a medulloblastoma, with typical 'small round blue cell' tumour appearances.
The location and appearances are also typical of a medulloblastoma in an adult.
It is important to remember that in older children and adults such tumour is more likely to be poorly marginated and demonstrates larger cyst formations. Adult medulloblastomas are usually located laterally, in the cerebellar hemispheres, with only 28% centred in the vermis (opposed to ~75% in children).