Imaging Department

Feb 19th, 2013Reported by Dr. Giang

Name: Nong Van Hieu Sex: Male Age: 5 years old. Dept: A13

Clinical

Headache & vomiting for 1 month No fever No seizure

Family’s history: older sister die when 10 years old because of Epilepsy.

CT Findings(From Ha Giang Hospital)

Hyperintense solid mass in 4th ventricle with edema surround

Hydrocephalus

NHP

MRI Findings(T2WI, axial, Pre C+)

Hyper-signal & Heterogenous mass in posterior fossa (43x40x49 mm)

Fill up IV ventricle Hydrocephalus Some necrosis areas Vermis invasion.

MRI Findings(Flair , Coronal, Pre C+)

Hyper-signal intensity. Spherical & well-defined

MRI Findings(T1WI, Sagital, Pre C+)

Hypointense to gray matter No hemorrhage intra mass

MRI Findings(Diffusion & ADC)

Diffusion: Decrease diffusion ADC : Hypo signal High density of cells

MRI Findings(T1WI, Axial, Post C+)

Strong enhancement Heterogenous (necrosis areas)

MRI Findings(T1WI, Sagital, Post C+)

Strong enhancement Heterogenous

MRI Findings(T1WI, Coronal, Post C+)

Strong enhancement Heterogenous

Diagnosis

Medulloblastoma

Background of MB Medulloblastoma: is a highly malignant primary brain tumor that

originates in the cerebellum or posterior fossa. ( PNET-MB)

Epidemilogy: 15- 20% of all Pediatric brain tumor

30-40% of posterior fossa tumor in children

Rare in adult. Location: - 4th ventricle, arises from roof.

- Cerebellar hemisphere : older children & adult. Age: 75% < 10 years. Most diagnosed by 5 year. Gender: M > F = 2-4 : 1 Classification: 4 major PNET-MB subtype

- Classic

- Desmoplastic

- Extensive nodular with advanced neuronal differentiation

- Large cell

Background of MB Presentation: - Ataxia , signs of increased intracranial

pressure.

(tumor rapid grow)

- Macrocephaly

- Cranial nerve palsies.

Treatment: Surgical excision , adjyvant chemotherapy Craniospinal irradiation if > 3 years

Top differential diagnosis: Ependymoma Atypical teratoid / rabdoid tumor

Thank you for attention!