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 »  Abstract
 »  Introduction
 »  Case report
 »  Discussion
 »  References

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Year : 2000  |  Volume : 48  |  Issue : 2  |  Page : 178-9

Cerebellar medulloblastoma in a 65 year old Indian male.




  »  Abstract

A case of cerebellar medulloblastoma in a 65 year old male is reported. Cerebellar medulloblastoma is classically seen during childhood, and less than 25% of these tumours are found in adults below 40 years of age. Rarely, cases are reported above the age of 40 years. So far only three cases have been reported in patients aged above 64 years and none of these case reports are from India.

How to cite this article:
Jaiswal A K, Chandra P S, Kamal R, Sharma M C, Mahapatra A K. Cerebellar medulloblastoma in a 65 year old Indian male. Neurol India 2000;48:178


How to cite this URL:
Jaiswal A K, Chandra P S, Kamal R, Sharma M C, Mahapatra A K. Cerebellar medulloblastoma in a 65 year old Indian male. Neurol India [serial online] 2000 [cited 2020 Oct 29];48:178. Available from: https://www.neurologyindia.com/text.asp?2000/48/2/178/1550




   »   Introduction Top

Medulloblastomas are malignant tumours of the posterior fossa in childhood and account for 20% of intracranial tumours and 30% of the posterior fossa tumours. Medulloblastomas are very rare in adulthood, representing no more than 1% of brain tumours in this age group. So far, only three cases above the age of 64 years have been reported,[1],[2],[3] the oldest case being a 73 year old male.[3] We report a case of medulloblastoma in a 65 year old man.


   »   Case report Top

A 65 year old male presented with history of headache, vomiting and difficulty in walking for 2 months. Fundus examination showed bilateral papilloedema. He had bilateral cerebellar dysfunction and lateral gaze nystagmus. Routine haematological parameters and serum biochemical tests showed no abnormality. Ultrasound abdomen, bone scan and chest x-ray were normal. MRI scan showed a well defined, mixed intensity, heterogeneous mass lesion within the vermis of the cerebellum [Figure - 1]. MR spectroscopy showed a high choline peak and a reduced NAA peak suggestive of neoplastic process with high activity. Under general anaesthesia, a midline sub occipital craniectomy was performed and a large lobulated reddish vascular tumour was seen in the midline in the cisterna magna. The tumour was lifted from the fourth ventricle and was almost totally excised. Postoperatively, the patient made an uncomplicated recovery and was discharged on the 8th postoperative day. The histopathology and immunohistochemistry confirmed the diagnosis of medulloblastoma with glial differentiation. He received 5500 rads of radiation over a period of 6 weeks, alongwith chemotherapy (Carboplatin, VR 16 and Etoposide). The patient was doing well, when seen at 3 months of follow up.


   »   Discussion Top

Cerebellar medulloblastomas have been traditionally described as tumours of childhood. They are uncommon above the age of 20.[1],[2],[3],[4] Bailey and Cushing reported 5 cases of medulloblastomas in the age group of 20 years or older.[4] In a series of 37 patients reported by Pobereskin and Treip, 32% of the cases were older than 18 years.[5] Medulloblastomas are rare in the 4th decade and exceptional after 50 years of age.[1],[2],[3],[4],[5],[6],[7],[8] Kopelson et al described a case of medulloblastoma in a patient aged 50 years.[9] Spitz reported a case in a patient of 55 years.[10] Ingraham et al described two cases of cerebellar medulloblastomas aged 65 and 67 years.[1] The oldest case of medulloblastoma has been reported in a 73 year old male[1]
Presumably, cerebellar medulloblastomas are derived from remnants of the external granular layer, especially in the region of posterior medullary velum. Cerebellar medulloblastomas may show differentiation into various cells, for example neuroblasts or glial cells. Hence, they are regarded as cerebellar equivalent of 'primitive neuroectodermal tumour'.[4],[8],[11] The tumour in our case had areas of undifferentiated small round cells with glial differentiation as evidenced by the glial fibrillary background. Immunohistochemical staining for synaptophysin and GFAP, being positive, ruled out non-neurogenic small cell tumours such as malignant lymphoma and metastatic small cell carcinoma. Metastatic oat cell carcinoma may pose difficulty in diagnosis. This neoplasm, because of its neuroectodermal origin, often shows positive staining for neural type of intermediate filaments in the cytoplasm of the cells.[12] Careful x-ray studies ruled out this pathology. Moreover glial differentiation ruled out metastatic tumour. The prognosis in adult cases of medulloblatomas is not different from those in children. However, laterally situated desmoplastic medulloblastomas have a better outcome according to some authors.[8],[9],[10],[11]

 

  »   References Top

1.Ingraham FD, Bailey OT, Barker WF: Medulloblastoma cerebelli: Diagnosis, treatment and survivals, with a report of fifty-six cases. N Engl J Med 1948; 238: 171-174.   Back to cited text no. 1    
2.Marty- Double C, Barneon G: Le medulloblastome de l'adulte (a propas d'une serie de 22 cas). Ann Anat Pathol (Paris) 1974; 19: 189-210.   Back to cited text no. 2    
3.Kepes JJ, Morantz RA, Dorzab WE: Cerebellar medulloblastoma in a 73-year-old woman. Neurosurgery 1987; 21: 81-83.   Back to cited text no. 3    
4.Bailey G, Cushing H: Medulloblastoma cerebelli: A common type of midcerebellar glioma in childhood. Arch Neurol 1925; 14: 192-233.   Back to cited text no. 4    
5.Poberskin L, Treip C: Adult medulloblastoma. J Neurol Neurosurg Psychiatry 1986; 49: 39-42.   Back to cited text no. 5    
6.Arseni C, Ciurea AV: Statistical survey of 272 cases of medulloblastoma (1935-1978). Acta Neurochir (Wein) 1981; 57: 159-162.   Back to cited text no. 6    
7.Alexseeva VS: Medulloblatomas of the posterior cranial fossa in adults. Vopr Neurochir 1959; 6: 30-33.   Back to cited text no. 7    
8.Ojeda VJ, Armstrong BK, Cullity GJ et al: Medulloblastoma: A clinicopathological study of 42 cases. Med J Aust 1985; 143: 60-62.   Back to cited text no. 8    
9.Kopelson G, Linggood RM, Kleinman GM: Medulloblastoma: The identification of prognostic subgroups and implications for multimodality managements. Cancer 1983; 51: 312-319.   Back to cited text no. 9    
10.Spitz EB, Shenkin HA, Grant FC: Cerebellar medulloblastoma in adults. Arch Neurol 1947; 57: 417-422.   Back to cited text no. 10    
11.Kadin ME, Rubinstein LJ, Nelson JS: Neonatal cerebellar medulloblastoma originating from the fetal external granular layer. J Neuropathol Exp Neurol 1970; 29: 583-600.   Back to cited text no. 11    
12.Lehto VP, Stenman S, Miettinen M et al: Expression of a neural type of intermediate filament as a distinguishing feature between oat cell carcinoma and other lung cancer. Am J Pathol 1983; 110: 113-118.   Back to cited text no. 12    

 

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