Extraneural dissemination of cerebellar medulloblastoma detected by 18F-FDG PET/CT – a case report of a rare situation
Authors:
Lucia Kaliská 1; Monika Zacharovská 1; Marika Vereb 2; Martin Spurný 3; Pavel Bician 4; Robert Chrenko 5; Soňa Balogová 6
Authors‘ workplace:
Inštitút nukleárnej a molekulárnej medicíny, Banská Bystrica, Slovensko
1; Nuklearmedizin, Klinikum Kassel, Nemecko
2; M. R Institute, s. r. o., Banská Bystrica, Slovensko
3; Klinika pediatrickej onkológie a hematológie, Detská fakultná nemocnica, Banská Bystrica, Slovensko
4; Neurochirurgické oddelenie, Landesklinikum Wiener Neustadt, Rakúsko
5; Klinika nukleárnej medicíny LF UK a OÚSA, Bratislava, Slovensko
6
Published in:
NuklMed 2015;4:73-78
Category:
Casuistry
Overview
In patients with medulloblastoma, extraneural metastases are well-known but very rare phenomenon. Herein we report a case of 11-year-old boy with medulloblastoma in cerebellar vermis, with early dissemination in spinal canal, treated by surgery, craniospinal irradiation and high-dose chemotherapy. Three months after completion of treatment, the recurrent disease was identified in frontal lobe. The patient underwent surgery and radiotherapy; second-line chemotherapy was planned. After completion of radiotherapy the mass in left neck area appeared. Histology from lymph node excision confirmed metastasis of immature embryonal tumor, most likely anaplastic variant of medulloblastoma, however neuroblastoma was considered as well. To restage the disease 18F-FDG PET/CT and 123I-MIBG scans were performed. While 123I-MIBG study was completely negative, 18F-FDG PET/CT showed extensive metastatic disease with multiple FDG avid lesions through bone marrow, in lymph nodes and paranasal sinuses. MRI plays a major role in initial staging, grading and prognostic evaluation of medulloblastoma. 18F-FDG PET/CT is not routinely performed in re-staging of medulloblastoma, however, it may be useful to identify distant metastatic spread.
Key Words:
medulloblastoma, extraneural metastases, 18F-FDG PET/CT
Sources
1. MacDonald T, Packer RJ. Pediatric Medulloblastoma. Medscape. [online]. 2014. [cit. 2015-07-10]. Dostupné na: http://www.reference.medscape.com/article/987886-overview
2. Zitterbart K, Pavelka Z, Zitterbartová J. Meduloblastom: nejčastější zhoubný nádor mozku u dětí. Onkologie 2010;4:256–259
3. Louis DN, Ohgaki H, Wiestler OD et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97–109
4. Mazloom A, Zangeneh AH, Paulino AC. Prognostic factors after extraneural metastasis of medulloblastoma. Int J Radiat Oncol Biol Phys. 2010;78:72–78
5. Lai R. Survival of Patients With Adult Medulloblastoma. Cancer 2008;112:1568–1574
6. Sure U, Bertalanffy H, Isenmann S et al. Secondary manifestation of medulloblastoma: Metastases and local recurrences in 66 patients. Acta Neurochirurgica 1995;136:117-126
7. Kaya B, Kara PO, Karaagac M et al. Rare Spinal Cord Metastases in a Patient with Medulloblastoma Detected on FDG-PET/CT Imaging. J Nucl Med Radiat Ther [online]. 2015;6: [cit. 2015-07-10] Dostupné na: http://dx.doi.org/10.4172/2155-9619.1000206
8. Tripathi M, Jain N, Jaimini A et al. Demonstration of diffuse leptomeningeal metastasis in a treated case of medulloblastoma with F-18 FDG PET/CT. Clin Nucl Med 2009;34:530-532
9. Basu S, Gupta T, Jalali R et al. Detecting bone marrow metastasis in cerebellar medulloblastoma: Value of disease surveillance with FDG-PET in this setting. Indian J Cancer 2011;48:373-374
10. Kool M, Korshunov A, Remke M et al. Molecular subgroups of medulloblastoma: an international meta-analysis of transcriptome, genetic aberrations, and clinical data of WNT, SHH, Group 3, and Group 4 medulloblastomas. Acta Neuropathol 2012;123:473–484
11. Polkinghor WR, Tarbell NJ. Medulloblastoma: Tumorigenesis, Current Clinical Paradigm, and Efforts to Improve Risk Stratification. Nat Clin Pract Oncol. [online] 2007;4:295-304. [cit. 2015-07-10] Dostupné na: http://www.medscape.com/viewarticle/556328
12. Smoll NR. Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs). Cancer 2012;118:1313–1322
13. Northcott PA., Korshunov A., Witt H. Medulloblastoma Comprises Four Distinct Molecular Variants. J Clin Oncol 2011;29:1408-1414
14. Taylor MD, Northcott PA, Korshunov A et al. Molecular subgroups of medulloblastoma: the current consensus. Acta Neuropathol 2012;123:465–472
15. Gottardo NG, Hansford JR, McGlade JP et al. Medulloblastoma Down Under 2013: a report from the third annual meeting of the International Medulloblastoma Working Group. Acta Neuropathol 2014;127:189–201
Labels
Nuclear medicine Radiodiagnostics RadiotherapyArticle was published in
Nuclear Medicine
2015 Issue 4
Most read in this issue
- Optimization of reconstruction parameters for SPECT and SPECT/CT
- Extraneural dissemination of cerebellar medulloblastoma detected by 18F-FDG PET/CT – a case report of a rare situation