Osseous metastasis in medulloblastoma: MRI findings in an unusual case

Olson, Erik M.; Tien, R D; Chamberlain, Marc C.

doi:10.1016/0899-7071(91)90121-b

Cited by 14 publications

(9 citation statements)

References 6 publications

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“…In the present cases, bone marrow involvement by the malignant process resulted in abnormal signals when MR imaging was used. By contrast to our findings, Olson et al 9 reported a low signal intensity on T1-weighted and T2-weighted MR scans without contrast enhancement. However, the MR characteristics of bone marrow metastases from medulloblastoma are very rarely described and it is difficult to draw any conclusion from this discrepancy.…”

Section: Discussioncontrasting

confidence: 99%

High-dose chemotherapy with hematopoietic stem cell transplantation in adults with bone marrow relapse of medulloblastoma: report of two cases

Millot

Giraud

et al. 1999

Bone Marrow Transplant

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Summary:Extraneural relapses of medulloblastoma are associated with a very poor outcome. We present two cases of young adults who developed bone marrow metastases after treatment of medulloblastoma. A very good response to a sequentially scheduled combination of carboplatin and etoposide was observed. Then, high-dose chemotherapy was delivered consisting of busulfan and thiotepa followed by infusion of autologous hematopoietic stem cells. Toxicity of the conditioning regimen was acceptable. The patients remained free of disease 20 and 27 months from the time of relapse, respectively. Further studies are needed to evaluate the impact of high-dose chemotherapy in terms of survival of such patients. Keywords: adult medulloblastoma; metastases; chemotherapy; autologous stem cell transplantation Medulloblastoma, a malignant tumor originating in the cerebellum, generally occurs in the first decade of life. It is a rare disease in the adult population and represents less than 1% of adult brain tumors. Extraneural relapses of medulloblastoma represent 7 to 13% of recurrences and are associated with a very poor outcome. 1 Encouraging preliminary data have been reported in children with recurrent malignant brain tumors receiving high-dose chemotherapy with autologous bone marrow rescue. 2,3 We report two young adults who underwent autologous hematopoietic stem cell transplantation for bone marrow relapse of medulloblastoma. Case reports Patient 1In July 1995, a non-metastatic cerebellar medulloblastoma was diagnosed in a 22-year-old man. The tumor was totally resected and cranio-spinal radiation therapy was given postoperatively. Fifteen months later the patient complained of left hip pain. A pelvic magnetic resonance (MR) scan revealed diffuse low intensity signals on T1-weighted images, high intensity signals on T2-weighted images in the bone marrow of the left acetabulum and the body of the left ilium with enhancement after gadolinium administration ( Figure 1a). An open biopsy of the left ilium and a bone marrow biopsy of the right posterior iliac crest revealed marrow involvement with metastatic medulloblastoma cells. No evidence of recurrent tumor within the central nervous system was demonstrated. Combination chemotherapy consisting of carboplatin (160 mg/m 2 /day) and etoposide (100 mg/m 2 /day) for 5 days was administered. Cycles were repeated at 4 weekly intervals. The patient was symptom-free after the first course of chemotherapy. Bone marrow biopsy was normal after the second course of chemotherapy. He received a total of five courses of carboplatin-etoposide. There were no episodes of febrile neutropenia. The main toxicities were nausea and myelosuppression. After the fifth course of chemotherapy, MR revealed marked improvement in the left ilium and left acetabulum bone marrow signals (Figure 1b). Cytapheresis was performed after a 3 g/m 2 cyclophosphamide infusion followed by G-CSF administration, leading to the collection of 2 × 10 6 CD34 cells/kg (before cryopreservation) and 8.5 × 10 4 CFU-GM/kg (after ...

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Section: Discussioncontrasting

confidence: 99%

High-dose chemotherapy with hematopoietic stem cell transplantation in adults with bone marrow relapse of medulloblastoma: report of two cases

Millot

Giraud

et al. 1999

Bone Marrow Transplant

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“…Skeletal metastases may be blastic or mixed lytic/blastic, involve mainly the axial skeleton, and are twice as common in midline lesions when compared to hemispheric primary lesions [5,25]. Recently the MR appearance of osseous metastases has been described as having decreased signal intensity on both T1 and T2 weighted images [26,27].…”

Section: Recurrences and Metastasesmentioning

confidence: 99%

Neuroradiology of pediatric posterior fossa medulloblastoma

Blasér

Harwood-Nash

1996

J Neuro-Oncol

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Medulloblastoma of the cerebellum is a common intracranial neoplasm in children and presents many faces in medical imaging. Characteristic or classic features, such as increased attenuation on unenhanced CT, midline location and well defined margins, are commonly present in childhood cases of posterior foassa medulloblastoma, although atypical imaging features are being noted more frequently with the increased dependence on MR as the diagnostic modality of choice. Carefully performed CT and MR both initially provide suitable geography and characteristics, but MR is superior in the detection of pre- or post-operative neoplastic spread elsewhere in the subarachnoid space. Accurate establishment of disease extent is essential in planning both surgical resection and adjuvant therapy.

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“…The bones are most frequent locations of extraneural metastases with predominant involvement of pelvis occurring in 80 to 90% of these cases [7]. Other sites include lymph nodes, liver and lungs [7,8]. Rare subcutaneous seeding from medulloblastomas is reported [9].…”

Section: Discussionmentioning

confidence: 99%

“…It often manifests as pia arachnoid enhancement, occurring in 63% of patients with recurrent tumors on MRI [6]. Most of the patients with recurrent disease develop leptomeningeal tumor within 26 months of surgery [6] but late recurrences at 3.5 years and 9 years have also been reported, though rarely [6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Supratentorial metastases and routes of dissemination of medulloblastoma: Report of two cases

Kumar

Jha

2015

J Pediatr Neurol

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Two children of 4 and 18 years of ages developed multiple supratentorial metastases at 3 years and 8 months follow up respectively, following their gross total microsurgical excision of medulloblastomas. Both the children received standard doses of craniospinal irradiation following surgery. An adjuvant chemotherapy was also offered to the younger child (of 4 years), who developed recurrence at posterior fossa along with supratentorial metastases. It is concluded, that early supratentorial metastases may occur even following gross total excision, craniospinal irradiation and chemotherapy of medulloblastomas. Probable routes of dissemination remain subarachnoid, cerebrospinal fluid and leptomeningeal.

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Osseous metastasis in medulloblastoma: MRI findings in an unusual case

Cited by 14 publications

References 6 publications

High-dose chemotherapy with hematopoietic stem cell transplantation in adults with bone marrow relapse of medulloblastoma: report of two cases

High-dose chemotherapy with hematopoietic stem cell transplantation in adults with bone marrow relapse of medulloblastoma: report of two cases

Neuroradiology of pediatric posterior fossa medulloblastoma

Supratentorial metastases and routes of dissemination of medulloblastoma: Report of two cases

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