Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 59, Num. 2, 2011, pp. 319-320

Neurology India, Vol. 59, No. 2, March-April, 2011, pp. 319-320

Neuroimage

Medulloblastoma presenting as a non-lateralized calcified stone like mass in an adult

Baijal Gunjan¹, Sridhar Epari², Rakesh Jalali¹

¹ Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India
² Department of Pathology, Tata Memorial Centre, Parel, Mumbai, Maharashtra, India

Correspondence Address: Rakesh Jalali, NeuroOncology Group, Tata Memorial Centre, Parel, Mumbai, India, rjalali@tmc.gov.in

Date of Submission: 07-Apr-2011
Date of Decision: 07-Apr-2011
Date of Acceptance: 07-Apr-2011

Code Number: ni11095

PMID: 21483154

DOI: 10.4103/0028-3886.79171

A 46-year-old female presented with truncal ataxia and headaches of 2 months duration. Computed tomography (CT) scan showed a midline posterior fossa mass, which had strikingly heavy and dense calcification causing obstructive hydrocephalus. Magnetic resonance (MR) imaging confirmed the mass arising from the fourth ventricle, which was isointense on T1-weighted and mildly hyperintense on T2-weighted sequences. Gradient sequences showed extensive calcification. Imaging was suggestive of ependymoma [Figure - 1]. The patient subsequently underwent resection of the mass. Histopathology revealed a cellular tumor composed of cells with hyperchromatic nuclei of embryonal cell morphology. Mitoses and apoptosis were seen accompanied with large areas of chunky calcification, consistent with medulloblastoma. IHC corroborated the diagnosis of medulloblastoma.

Medulloblastoma forms only 0.4-1% of all adult CNS tumors. Commonest presentation is lateralized in adults and known to arise in midline in only 3%. ^[1] Medulloblastoma appears iso-hypointense on T1 and has variable intensity on T2 sequences. ^[2] Calcifications may appear in 20% cases of medulloblastoma and is almost always in the form of punctuate pattern. Calcifications (small punctuate foci to large masses) are seen in up to 80% of ependymomas and in oligodendrogliomas. ^[3] Large chunky calcification in the present case was indeed very unusual and, to the best of our knowledge, has not been reported so far. Histopathology was unequivocally consistent of a medulloblastoma.

We conclude that even though the diagnosis of medulloblastoma is rare in an adult with a midline posterior fossa tumor with dense calcifications, it must be borne in mind for optimal management of the patient.

References

Copyright 2011 - Neurology India

The following images related to this document are available:

Photo images