MEDULLOBLASTOMA IN ADULT: A CASE REPORT

ISABELLA FERNANDES DE AZAMBUJA VEDOVATO, JOAO MARCOS RODRIGUES LEMOS, MARIANA ANGELICA DA SILVA MIRANDA, THAYNA ALVES COIMBRA, GIULIA CAMYLA SANTOS CHIES MIRANDA, BIANCA RIBEIRO MORAIS

Resumo


Introduction: Medulloblastomas are cerebellar tumors with fast-growing, most common in children. Case Report: In June 2016, a 33 years-old man reported a posterior cervical pain initiated after a physical effort two months earlier, that irradiated as an intense frontal headache. His neurological examination was normal. The magnetic resonance imaging (MRI) showed an expansive lesion in the left*** cerebellar hemisphere. A lumbar puncture was performed, and showed anormal cerebrospinal fluid (CFS). He was submitted to lesion biopsy and ventriculoperitoneal (VP) shunting, and the immunohistochemistry indicated medulloblastoma.Discussion and Conclusion: Medulloblastoma is very rare in adulthood and it presents different manifestations, which difficult the diagnosis and can be easily confused with another disorders.
INTRODUCTION
Medulloblastomas are the most common malignant brain tumours of childhood. They originate in the primitive neurological cells of the cerebellar marrow (embryonal origin), and present as midlinemasses in the fourth ventricle. Medulloblatomas are relatively rare, accounting for less than 2% of all primary brain tumors and 18%-20% of all pediatric brain tumors. The most common symptoms of this tumor, like vomiting, nausea and morning headaches, are associated with increased intracranial pressure. Sometimes, there are also loss of motor coordination, mental confusion and visual changes.
CASE REPORT
In June 2016, a 33 years-old man reported a posterior cervical pain initiated two months later, after a physical effort. The pain irradiated to frontalregion, and was defined as a pressure headache that occurred mainly at mornings, disrupting daily activities and increased with movements. The patient denied nausea, vomiting, photo and phonophobia. His neurological examination was normal, but due to the atypical characterization of the pain, a magnetic resonance imaging (MRI) of encephalon and cervical spine was requested.
The MRI showed an expansive lesion in the left cerebellar hemisphere (images 1 and 2), compressing the fourth ventricle, with thickening of the meninges, causing Arnold-Chiari syndrome (herniation of cerebellum through the foramen magnum) and hydrocephalus (image 3).

The patient was referred to the Neurosurgery, which performed an intraventricular cerebrospinal fluid puncture (CSF) in August 2016. The results showed a CFS clear and colorless with leukocyte, red blood cell, protein and glucose levels within normal range. Gram staining, Pandy's reaction, Venereal Disease Research Laboratory (VDRL) test and Mycobacterium tuberculosis Polymerase Chain Reaction (MTB-PCR) were negative. Due to the high prevalence in our region, empirical treatment for tuberculosis was started.In 14th November, another MRI was done and despite the treatment, there was no improvement.
The patient was submitted to lesion biopsy and ventriculoperitoneal (VP) shunting. Microscopy results showed malignant tumor of small cells suggestive of neuroectodermal embryonic neoplasm. The immunohistochemistry indicated medulloblastoma.

DISCUSSION AND CONCLUSION
Medulloblastoma is very rare in adulthood and its diagnosis is difficult to be determined. The symptoms caused by this tumor have different manifestations and can easily be confused with other syndromes and disorders, especially due to the low epidemiology in the higher age groups. In our report, the diagnosis was only closed due to immunohistochemistry examination.


Referências


FARIED, A.; PRIBADI, M. A.; SUMARGO, Sheila; ARIFIN, M. Z.; HERNOWO, B. S. Adult medulloblastoma: A rare case report and literature review. Surgical Neurology International.2016; v. 7: p. 481–484. HINZ, C.; HESSER, D. Focusing On Brain Tumors: Medulloblastoma.American Brain Tumor Association. 2015. JAKACKI, R. I. Treatment strategies for high-risk medulloblastoma and supratentorial primitive neuroectodermal tumors: review of the literature. Journal of Neurosurgery. 2005; v. 102: p. 44-52.

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