radiología en la red: Medulloblastoma MRI

Estándar
Clinical Details  : From last one and half months has tremolousness involving left arm, episodic associated with facial twitching, unsteadiness of gait and severe headaches associated with vomiting. No significant illness in the past. Examination shows bilateral papilloedema, brisk reflexes, plantars flexor.

MRI BRAIN WITH CONTRAST REPORT

MR study of brain reveals an ~ 35x37mm well defined solid signal intensity tumor in fourth ventricle causing moderate obstructive hydrocephalous, peri ventricular ooze of Csf. Diffuse cerebral odema. Prominent Sub Arachnoid space around optic nerves owing to raised ICT.
Cysts noted at the periphery of lesion, solid component show mild patchy enhancement on post contrast, restricted diffusion on Dw images.

Imaging wise primary diagnosis : Medulloblastoma.

No DDs suggested.  

Operated with posterior fossa craniotomy.

REPORT OF HISTOPATHOLOGICAL EXAMINATION
Specimen         :     Biopsy – 4th ventricular SOL.
Gross Appearance    :     The specimen consists of few soft to friable fragments of dull grey-white tissue; together measuring 3.0X2.5X1.3 cm. The entire tissue is submitted for processing.
Codes : A and B.
Microscopy        :     Sections A and B both show fragmented bits of monotonous undifferentiated cellular neoplasm of probable medulloblastic origin. The tumour consists of cohesive sheets of fairly monotonous appearing, intermediate sized, round to oval cells having hyperchromatic, minimally pleomorphic nuclei with coarse chromatin and scanty eosinophilic cytoplasm. Few foci reveal nuclear moulding, while many areas show elongation of nuclei. The neoplasm in couple of foci show vague nodular configuration with nodules comprising of rather pale-stained neoplastic cells. The interstitium at places appears desmoplastic and shows compressed congested blood vessels. An occasional focus shows mitosis. No classical               Homer-Wright rosettes seen. The background shows minimal fibrillary appearance. Also seen are couple of fragments of cerebellar parenchyma.

Final Diagnosis                   :     Embryonal malignant small blue cell tumor – Medulloblastoma; undifferentiated.

Adv. :     Ancillary IHC studies are mandatory for confirmation and definite lineage typing.

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