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Published on: October 14, 2022
Peritoneal metastasis of a cerebellar medulloblastoma through a ventriculoperitoneal shunt: A case report
Ranya Aqamour1,2, Mohammed Leknani2, Siham Nasri1,2
1Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
Insights
Ventriculoperitoneal shunts can rarely lead to medulloblastoma metastasis in the abdomen. This case highlights the risk of peritoneal spread via shunts in pediatric cancer patients.
Area of Science:
- Pediatric Oncology
- Neurosurgery
- Medical Imaging
Background:
- Medulloblastoma is an aggressive pediatric brain tumor requiring surgical resection and cerebrospinal fluid (CSF) diversion.
- Ventriculoperitoneal (VP) shunts are commonly used to manage increased intracranial pressure in these patients.
- Intraperitoneal metastasis from medulloblastoma is a rare but serious complication.
Observation:
- A 14-year-old boy with a history of medulloblastoma developed acute abdominal symptoms.
- Imaging revealed multiple peritoneal masses and lymphadenopathy.
- Biopsy confirmed metastatic medulloblastoma in the peritoneal cavity.
Findings:
- The patient's VP shunt was implicated in the dissemination of medulloblastoma cells to the peritoneal cavity.
- This metastatic pathway presents a significant challenge in managing the disease.
- The metastatic form involving the VP shunt carries a poor prognosis.
Implications:
- This case underscores the potential risk of shunt-related metastasis in pediatric medulloblastoma.
- It emphasizes the need for vigilance regarding abdominal symptoms in patients with VP shunts.
- Further research into preventative strategies and novel therapeutic approaches for shunt-related metastasis is warranted.
Abstract:
Medulloblastoma is a frequent and aggressive pediatric tumor. It causes intracranial hypertension, necessitating ventriculoperitoneal shunting with surgical resection. Intraperitoneal metastases are rare and result from the migration of neoplastic cells through the shunt and into the peritoneal cavity. This metastatic form involving the ventriculoperitoneal shunt has a poor prognosis, making therapeutic management even more difficult. We report the case of a 14-year-old boy with a history of medulloblastoma of the cerebellum who was initially treated with complete resection of the tumor with placement of a ventriculoperitoneal shunt, followed by radiotherapy and chemotherapy, with good progression until he presented to the emergency department with acute abdominal symptoms. Imaging revealed multiple peritoneal masses with intra- and retroperitoneal lymphadenopathies. An ultrasound-guided biopsy revealed a metastatic medulloblastoma in the peritoneal cavity, and the patient underwent chemotherapy. The placement of the ventriculoperitoneal shunt in the tumor dissemination is therefore to blame.
