Medulloblastoma with leptomeningeal metastasis

Case contributed by Dr Ahmed Abdrabou

Presentation

Known patient with medulloblastoma underwent surgery and received chemo/radiotherapy and now for follow up.

Patient Data

Age: 15 years
Gender: Male

4th ventricular cavity midline ill defined mass, was noted displaying low signal on T1, bright signal on T2, diffusion restriction on DWI and heterogeneous contrast enhancement. There was extension along the right foramen of Luschka as well.

Associated supratentorial hydrocephalic changes were noted with CSF permeation.

Follow up study of the brain and spine was done 2 years after the prior study. There was diffuse nodular leptomeningeal enhancement of the brain sulci, CSF cisters, around the spinal cord as well as the roots of cauda equina representing diffuse leptomeningeal metastasis. 

Moreover, there was diffuse intramedullary abnormal T2 signal intensity involving the whole spinal cord which was consistent with radiation changes. 

Post operative changes of the posterior fossa were noted.

Case Discussion

Following surgical removal of the 4th ventricular mass, histopathology revealed medulloblastoma. The patient received whole brain and whole spine radiotherapy. After 2 years, on the follow up study, diffuse leptomeningeal spread was detected. 

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Case information

rID: 68025
Published: 7th May 2019
Last edited: 9th May 2019
Inclusion in quiz mode: Included
Institution: Ain Shams University

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