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Medulloblastomas in late middle age and the elderly: report of 2 cases
D A Ramsay1, J Bonnin, D R MacDonald
1Department of Clinical Neurological Sciences, Victoria Hospital, London, ONT, Canada.
Abstract:
Medulloblastomas may be difficult to recognize in late middle age and the elderly because of their rarity and their histological similarity, particularly in frozen sections, to common, poorly differentiated, metastatic tumors, notably the small cell carcinoma of lung. This report describes the occurrence of medulloblastomas in a 66-year-old male (case 1) and a 65-year-old female (case 2). Both tumors appeared radiologically as cystic cerebellar masses of irregular shape and variable intensity on magnetic resonance imaging; in each case microscopic examination revealed a primitive neuroectodermal tumor with focal astrocytic differentiation and desmoplasia. Case 1 died 23 months after surgery; an autopsy revealed extensive dissemination of the tumor to the bone marrow, small collections of malignant cells in the spinal subarachnoid space, and no evidence of local recurrence. Case 2 is well 29 months after her operation. The possibility of a medulloblastoma should be considered when a solitary cerebellar lesion is discovered in a middle-aged or elderly patient without a demonstrable extraneural primary site.
Insights
Medulloblastomas are rare in older adults and can mimic other cancers. This report highlights two cases, emphasizing the need for consideration in elderly patients with solitary cerebellar lesions.
Area of Science:
- Neuro-oncology
- Geriatric Medicine
- Pathology
Background:
- Medulloblastomas are rare primary brain tumors typically diagnosed in children.
- In older adults, medulloblastomas can be misdiagnosed due to rarity and histological overlap with metastatic tumors like small cell lung carcinoma.
Observation:
- This report details two cases of medulloblastoma in patients aged 66 and 65.
- Radiological findings included cystic cerebellar masses with irregular shapes and variable MRI intensity.
- Microscopic examination revealed primitive neuroectodermal tumors with astrocytic differentiation and desmoplasia.
Findings:
- One patient experienced extensive tumor dissemination to the bone marrow and spinal subarachnoid space, succumbing 23 months post-surgery.
- The second patient remained well 29 months after surgery, indicating potential for varied prognoses.
Implications:
- Clinicians should consider medulloblastoma in middle-aged and elderly patients presenting with solitary cerebellar lesions.
- Early recognition and accurate diagnosis are crucial for appropriate management and improved outcomes in this demographic.