Medulloblastoma with leptomeningeal seeding
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Known case of medulloblastoma from 9 months ago, presented with headache and projectile vomiting.
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Contrast-enhanced MRI shows recurrence of a large heterogeneous and hemorrhagic mass with intense enhancement at right cerebellar hemisphere with adjacent tentorial enhancement and intraventricular extension. There is evidence of extension to suprasellar and pineal region. In addition, a diffuse and relatively thick mass forming ependymal enhancement of lateral and third ventricles with thick and nodular enhancement of fourth ventricle and foramen of Monro is observed. Ill-defined margin and parenchymal enhancement at right frontal lobe is noted too,
Histopathologic findings of the tumor that was operated 9 months ago confirmed Desmoplastic nodular type of medlloblastoma.
Medulloblastoma is the most common pediatric CNS malignancy and the most common primary tumor of the posterior fossa. The desmoplastic nodular subtype was described as a circumscribed arachnoid cerebellar sarcoma.
Subarachnoid seeding in medulloblastomas is common (33%). CT findings of leptomeningeal spread include sulcal and cisternal effacement with leptomeningeal and ependymal & subependymal enhancement.