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Title: Medulloblastoma

Medulloblastoma: A type of brain tumor that tends to occur in children, arise in the cerebellum (in the lower part of the brain), and spread along the spine. Medulloblastoma is the most common type of primary brain tumor in childhood. Medulloblastomas occasionally metastasize outside the central nervous system, usually to bone. Treatment involves surgery, radiotherapy, and chemotherapy.

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Demonstration of the salient microscopic features of a classic medulloblastoma.

Video source: Pathweb
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Neuroradiology brain tumor board review. This lecture is geared towards the ABR core exam for residents, but it would be useful for review for the ABR certifying exam or certificate of added qualification (CAQ) exam for neuroradiology.

This case shows you a posterior fossa mass in a child. It his relatively homogeneously T2 hyperintense with relatively avid central enhancement on post-contrast imaging. On ADC, it is relatively dark centrally. A sagittal FLAIR image looks like it confirms that the mass is arising from the cerebellar wall of the ventricle and is displacing the ventricle anteriorly.

1:07 Anytime you have a posterior fossa mass in a child, you should be able to list a differential diagnosis, which includes:

pilocytic astroctyoma
ependymoma
medulloblastoma
atypical teratoid/rhabdoid tumor (ATRT)

These are listed in order of decreasing ADC values, because the tumors at the bottom are more cellular and have more tightly packed cells that will be bright on DWI and dark on ADC.

2:14 The diagnosis is: medulloblastoma

Medulloblastomas are aggressive tumors in children most commonly found in the posterior fossa. They can be differentiated from other tumors in these age groups by their aggressive appearance and lower ADC values. They arise from the walls of the 4th ventricle or cerebellar hemispheres. There are 4 types (WNT, SHH, group 3, and group 4), but for most radiologists this is beyond the expected knowledge. Genetic features will ultimately guide the prognosis and treatment.

The main differential diagnosis in a child with a lesion such as this is ATRT. I recommend an age based approach to making your differential diagnosis. Because ATRT patients usually are around 6 months old, if a patient is less than 2 years old, choose ATRT. If older, choose medulloblastoma. This will not always be true but is probably true more than 95% of the time.

Stay tuned for additional content and check out all the board review content at
https://learnneuroradiology.co....m/examprep/board-rev

Understanding a brain tumor's genetic makeup has led to more effective and personalized treatments. Learn from brain tumor experts on this American Brain Tumor Association's Educational Webinar, "Your Tumor's Personality: The Importance of Molecular Profiling."

This webinar will be presented by Dr. Daniel J. Brat, MD, PhD, Chair of Pathology at Northwestern University Feinberg School of Medicine.

Webinar Overview:
• Receive an overview of the basics of precision medicine
• Understand the difference between standard pathology report, genetic testing, and molecular profiling
• Learn about the different types of molecular profiling
• Understand how the testing done can impact your diagnosis and treatment plan
• Q&A

The ABTA educational webinars are designed for brain tumor patients and caregivers to learn more about brain tumor types, treatments and research. Webinars are 60 minutes and free to all who are interested. To learn about upcoming webinars, visit https://bit.ly/3xev6HE.

For more information or additional resources, contact the American Brain Tumor Association at (800) 886-2282, info@abta.org or visit https://www.abta.org/.

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Precious Gift (unknown author)

When times seem too hard to bear and I feel like giving up
I vision your beautiful face, the twinkle of your eyes and things of such
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Is a mother and daughter bond that can never be torn
With the strength and guidance of God and the blessings he pours down from above
I want to be the best mom I can be to you and embrace you with all my love
You are as precious as a flower and as gorgeous as a rose
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You are brighter than any star in the sky every time you smile
I want you to be proud of who you are and strive to be the best
Put forth efforts to achieve your goals and let God do the rest
I will always be your mother first, but I'm also your friend
You are the most precious gift, that I've ever been given

With All My Love,
Mommy

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Zamirra's Diagnosis- (Pnet) Medulloblastoma Group 3,Grade 4

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