Benign skull and subdural lesions in patients with prior medulloblastoma therapy
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CASE-BASED REVIEW
Benign skull and subdural lesions in patients with prior medulloblastoma therapy Kristiyana Kaneva 1
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& Nitin Wadhwani & Arthur J. DiPatri Jr & Susan Palasis & Stewart Goldman & Jessie Aw-Zoretic
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Received: 13 July 2020 / Accepted: 28 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To report on our institutional cohort of patients and review the literature of medulloblastoma patients who developed skull/subdural-based lesions following treatment. Methods Following institutional review board (IRB) approval, we retrospectively reviewed the medical records of four children with a history of treated medulloblastoma who developed non-specific skull-based/subdural lesions incidentally found on surveillance imaging. Results Biopsies of the lesions proved the pathology to be low grade and included inflammatory myofibroblastic tumor, cortical fibrous defect consistent with fibroma, fibrous tissue, and fibrous dysplasia. The finding of calvarial or subdural fibrous lesions in children following therapy for medulloblastoma was noted in four out of 201 (136 with available follow-up data) medulloblastoma patients seen or discussed in our institution over the past 10 years. Conclusions These lesions can grow over time and pose a differential diagnostic challenge with metastatic disease when identified. The skull and subdural space should be scrutinized for secondary lesions on surveillance imaging of patients with medulloblastoma who have received craniospinal irradiation as knowledge of this benign occurrence will assist with management. Keywords Pediatric brain tumor . Medulloblastoma . Skull lesion . Bone lesions . Fibrous
Introduction Medulloblastoma is the most common pediatric malignant brain tumor accounting for approximately 20% of childhood brain tumors [3]. The standard of care for patients with
* Kristiyana Kaneva [email protected] * Jessie Aw-Zoretic [email protected] 1
Division of Hematology-Oncology, Neuro-Oncology & Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Chicago, IL 60611-2991, USA
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Division of Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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Division of Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 East Chicago Avenue, Box 9, Chicago, IL 60611-2991, USA
medulloblastoma diagnosed 3 years of age and older includes maximum safe surgical debulking and craniospinal irradiation (CSI) with local boost radiotherapy followed by adjuvant chemotherapy [5, 11, 12]. The progression-free survival (PFS) for children with medulloblastoma diagnosed at > 3 years of age ranges from 60 to 67% for high-risk disease to 75–80% for average-risk disease at 5 years [9, 13, 18]. However, medulloblastoma surv
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