Medulloblastoma - adult

Case contributed by A.Prof Frank Gaillard

Patient Data

Age: 35 years
Gender: Female
CT

CT brain

CT demonstrates a mass within the left cerebellar hemisphere. Is is composed of mixed solid and cystic components and is surrounded by tumour oedema.

The solid component appears slightly hyperdense. Following administration of contrast, vivid enhancement of the solid component is present.

MRI

MRI brain

MRI demonstrates a mass within the left cerebellar hemisphere. Is is composed of mixed solid and cystic components and is surrounded by a mantle of tumour oedema.

The solid component demonstrates restricted diffusion on DWI. Following administration of contrast, vivid enhancement of the solid component is present.

Case Discussion

The differential is of a haemangioblastoma, high grade glioma, a metastasis or of an adult medulloblastoma. The hypderdensity, excetic location, and restricted diffusion are all consistent with the latter, confirmed at pathology. 

Histology

Microscopic Description:

Sections show a highly cellular tumour mass composed of cells with hyperchromatic oval nuclei and little visible cytoplasm. The nuclei have coarsely clumped chromatin and inconspicuous nucleoli. Mitotic activity and individual cell necrosis and apoptosis are frequent. In some areas, the nuclei show a tendency to mold to one another. The cells are arranged in solid disorganized sheets and in small lobules and columns separated by collagenous septa. Multiple small cystic spaces are present but there is no geographic necrosis. One small fragment of recognizable cerebellar cortex is present and shows diffuse infiltration by neoplastic cells. Immunohistochemistry shows diffuse cytoplasmic reactivity for NSE and synaptophysin and occasional cells are positive for GFAP and S-100. The tumour is negative for cytokeratin, LCA, HMB-45 and Mel A.

Final diagnosis: Medulloblastoma

 

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Case information

rID: 5328
Case created: 3rd Jan 2009
Last edited: 14th Feb 2016
Inclusion in quiz mode: Included

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