Extra-axial desmoplastic medulloblastoma in adult cerebellopontine angle: Case report and noninvasive molecular subgrouping utilizing magnetic resonance imaging-based radiomics nomogram

Sundus Ali; Adnan Qasim; Shahzaib Tasdique; Muhammad Sarwar; Shahzad Shams

doi:10.4103/ajns.AJNS_525_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(03): 618-622
DOI: 10.4103/ajns.AJNS_525_20

Case Report

Extra-axial desmoplastic medulloblastoma in adult cerebellopontine angle: Case report and noninvasive molecular subgrouping utilizing magnetic resonance imaging-based radiomics nomogram

Authors

Sundus Ali

Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore
Adnan Qasim

Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore
Shahzaib Tasdique

Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore
Muhammad Sarwar

Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore
Shahzad Shams

Department of Neurosurgery, Mayo Hospital, King Edward Medical University, Lahore

Abstract

Cerebellopontine angle (CPA) is an atypical site for adult medulloblastoma (MB) with only 12 cases reported in pure extra-axial location. None was predicted on preoperative imaging while the most common misdiagnosis was petrous meningioma. We add the 13^th case to this list, attempting to reiterate the radiological features for preoperative prediction of this rare pathology on conventional magnetic resonance imaging (MRI). Molecular subtyping also is not yet reported for adult extra-axial CPA MB. We propose the routine use of MRI-based nomograms, in atypical CPA extra-axial masses, for noninvasive prediction of molecular subgroup, especially in resource-limited setups that lack the facility of genetic profiling.

Key-words:

Adult - cerebellopontine angle - medulloblastoma - radiomics

Full Text

References

References
1 Giordana MT, Schiffer P, Lanotte M, Girardi P, Chio A. Epidemiology of adult medulloblastoma. Int J Cancer 1999;80:689-92.
2 Ratha V, Karmarkar VS, Deopujari CE. Extra-axial cerebellopontine angle adult medulloblastoma: An unusual presentation at an unusual site. Indian J Neurosurg 2019;08:203-6.
3 Doan NB, Patel M, Nguyen HS, Janich K, Montoure A, Shabani S, et al. A rare extra-axial midline tentorial adult medulloblastoma with dural-tail sign mimicking a meningioma. Asian J Neurosurg 2018;13:475-7.
4 Becker RL, Becker AD, Sobel DF. Adult medulloblastoma: Review of 13 cases with emphasis on MRI. Neuroradiology 1995;37:104-8.
5 Akay KM, Erdogan E, Izci Y, Kaya A, Timurkaynak E. Medulloblastoma of the cerebellopontine angle – Case report. Neurol Med Chir (Tokyo) 2003;43:555-8.
6 Singh SK, Kumar N. Extraaxial cerebellopontine angle medulloblastoma with multiple intracranial metastases in adult: A rare case report with a review of literature. Asian J Neurosurg 2020;15:695-8.
7 Gil-Salú JL, Rodríguez-Peña F, López-Escobar M, Palomo MJ. et al. Meduloblastoma de presentación extra-axial en el ángulo pontocerebeloso. Neurocirugia 2004;15:285-9.
8 Fallah A, Banglawala SM, Provias J, Jha NK. Extra-axial medulloblastoma in the cerebellopontine angle. Can J Surg 2009;52:E101-E102.
9 Furtado SV, Venkatesh PK, Dadlani R, Reddy K, Hegde AS. Adult medulloblastoma and the “dural-tail” sign: Rare mimic of a posterior petrous meningioma. Clin Neurol Neurosurg 2009;111:540-3.
10 Singh M, Cugati G, Symss NP, Pande A, Vasudevan MC, Ramamurthi R. Extra axial adult cerebellopontine angle medulloblastoma: An extremely rare site of tumor with metastasis. Surg Neurol Int 2011;2:25.
11 Spina A, Boari N, Gagliardi F, Franzin A, Terreni MR, Mortini P. Review of cerebellopontine angle medulloblastoma. Br J Neurosurg 2013;27:316-20.
12 Bahrami E, Bakhti S, Fereshtehnejad SM, Parvaresh M, Khani MR. Extra-axial medulloblastoma in cerebello-pontine angle: A report of a rare case with literature review. Med J Islam Repub Iran 2014;28:57.
13 Goudihalli SR, Pathak A, Brar R, Mundi I, et al. Reappraisal of cerebellopontine angle medulloblastomas: Report of a fatal case and lessons learned. Interdiscip Neurosurg Adv Tech Case Manag 2018;12:20-3.
14 Dasgupta A, Gupta T. Radiogenomics of medulloblastoma: Imaging surrogates of molecular biology. J Transl Genet Genomics 2018;2:15. [doi: 10.20517/JTGG.2018.21].
15 Remke M, Hielscher T, Northcott PA, Witt H, Ryzhova M, Wittmann A, et al. Adult medulloblastoma comprises three major molecular variants. J Clin Oncol 2011;29:2717-23.
16 Zhao F, Ohgaki H, Xu L, Giangaspero F, Li C, Li P, et al. Molecular subgroups of adult medulloblastoma: A long-term single-institution study. Neuro Oncol 2016;18:982-90.
17 Kool M, Korshunov A, Pfister SM. Update on molecular and genetic alterations in adult medulloblastoma. Memo 2012;5:228-32.
18 Ellison DW, Dalton J, Kocak M, Nicholson SL, Fraga C, Neale G, et al. Medulloblastoma: Clinicopathological correlates of SHH, WNT, and non-SHH/WNT molecular subgroups. Acta Neuropathol 2011;121:381-96.
19 Zhao F, Li C, Zhou Q, Qu P, Wang B, Wang X, et al. Distinctive localization and MRI features correlate of molecular subgroups in adult medulloblastoma. J Neurooncol 2017;135:353-60.
20 Aljoghaiman M, Taha MS, Abdulkader MM. Cerebellar medulloblastoma in middle-to-late adulthood. Case Rep Pathol 2018;2018:5425398.
21 Dasgupta A, Gupta T, Pungavkar S, Shirsat N, Epari S, Chinnaswamy G, et al. Nomograms based on preoperative multiparametric magnetic resonance imaging for prediction of molecular subgrouping in medulloblastoma: Results from a radiogenomics study of 111 patients. Neuro Oncol 2019;21:115-24.