Primary subdural tumor mimicking subdural hematoma: illustrative case

Area of Science:

• Pediatric neuro-oncology
• Neuroradiology
• Surgical neuropathology

Background:

• Rare pediatric subdural tumors can present symptomatically similar to subdural hematomas.
• Differential diagnoses for subdural masses in children include lymphoma, sarcoma, and metastatic cancers.

Purpose of the Study:

• To highlight the diagnostic challenges and clinical presentation of a rare primary subdural tumor in a pediatric patient.
• To emphasize the importance of advanced imaging and molecular analysis in diagnosing and classifying challenging intracranial neoplasms.

Main Methods:

• Case report of a 3-year-old boy with a history of chronic subdural hematoma.
• Diagnostic imaging included CT and Gadolinium-enhanced MRI.
• Histopathological, immunohistochemical, and genetic analyses (including HIST1H3B K37 mutation) were performed.
• Methylation profiling was utilized for tumor classification.

Main Results:

• A partially organized bilateral subdural mass with brain invasion was identified.
• The tumor exhibited rapid regrowth post-resection and was diagnosed as an unclassifiable malignant intracranial tumor with epithelioid features.
• Despite multimodal treatment (surgery, chemoradiotherapy), the patient succumbed to the disease within one year.

Conclusions:

• Primary subdural tumors in children are exceptionally rare but must be considered in the differential diagnosis.
• Gadolinium-enhanced MRI revealing an enhanced nodule protruding into the brain parenchyma is a critical finding.
• The case underscores the need for comprehensive diagnostic workup, including molecular profiling, for accurate tumor classification and management.