Vermian metastasis and subependymoma

Case contributed by Frank Gaillard


History of adenocarcinoma of the colon 5 years earlier

Patient Data

Age: Adult

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Posterior fossa


A cerebellar mass lesion is seen epicentered on the vermis with low T2 signal and perifocal edema. It shows wall enhancement and internal heterogeneous post contrast enhancement. No diffusion restriction identified. It is compressing the 4th ventricle. In view of patient's history, features are suggestive of vermian metastasis.

Incidental note of a subependymal lesion at the inferior part of 4th ventricle with isointense signal in all pulse sequences and no post contrast enhancement, suggestive of subependymoma.

Annotated images


Subependymoma (white arrow) 

Bottom of adenocarcinoma metastasis (red arrow)

Case Discussion

Final Diagnosis: 

  • A. Brain, fourth ventricular region: Subependymoma.
  • B. Cerebellum, vermis: Metastatic adenocarcinoma - colon.

Microscopic Description: 

A. Sections show a relatively sparsely cellular tumor characterized by small clusters and short linear profiles of tumor cells with bland round nuclei, within a fibrillar glial background. Areas of necrosis, vascular neogenesis, significantly increased cellularity or elevated mitotic activity, are not seen. 

B. Sections show small fragments of cerebellar tissue containing metastatic carcinoma showing features consistent with metastatic adenocarcinoma, likely of colonic origin. Tumor necrosis is evident.

5 years earlier: Terminal ileum and right colon resection showing well-differentiated adenocarcinoma of the cecum/ascending colon

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