Glioblastoma occurring at the site of a previous medulloblastoma following a 5-year remission period

Sarah E. Martin, Daniel J. Brat, Gail Vance, Ryan Stohler, Haki Choi, Annette C. Douglas-Akinwande, Eyas M. Hattab

Research output: Contribution to journalArticle

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Abstract

We describe a case of a 14-year-old boy who developed a cerebellar and brainstem glioblastoma 5 years after treatment for a medulloblastoma. The patient first presented in 2003 with 9 months of vomiting and a 9-kg weight loss. A head MRI showed a heterogeneously enhancing posterior fossa mass with hydrocephalus. Gross total resection was performed and the tumor was consistent with a classic medulloblastoma. Postoperative chemotherapy and craniospinal radiation was administered. The patient remained tumor-free until 2008, at which time he presented with right-sided weakness and numbness, left eye pain, vomiting and weight loss. Imaging showed abnormalities within the posterior pons, medulla, inferior cerebellar peduncles, cerebellar hemispheres and cervicomedullary junction with expansion of the medulla and cervical spinal cord. Due to the location of the lesion, biopsy was felt to be too risky and was avoided. Despite receiving chemotherapy, his symptoms continued to worsen and he died 4 months later. Post mortem examination limited to the brain and spinal cord confirmed the radiographic extent of the tumor. Microscopic examination showed a highly cellular infiltrative glial neoplasm with extensive palisading necrosis. A diagnosis of glioblastoma was rendered. The question of whether the first and second tumors were related is of potential clinical and academic interest. The first tumor was synaptophysin-positive and GFAP-negative, consistent with medulloblastoma. The second tumor was synaptophysin-negative and focally GFAP-positive, consistent with glioblastoma. The glioblastoma displayed EGF receptor amplification, and interestingly, it also displayed MYCN amplification; both tumors showed low level PTEN deletion. The medulloblastoma displayed a signal pattern consistent with an isochromosome 17q, while the glioblastoma showed some cells with an isochromosome 17q signal pattern amid a background of cells with abundant chromosomal instability. The relationship between these two tumors, particularly with regard to various molecular events, is discussed.

Original languageEnglish
Pages (from-to)543-550
Number of pages8
JournalNeuropathology
Volume32
Issue number5
DOIs
StatePublished - Oct 2012

Fingerprint

Medulloblastoma
Glioblastoma
Neoplasms
Isochromosomes
Synaptophysin
Vomiting
Weight Loss
Eye Pain
Drug Therapy
Chromosomal Instability
Pons
Hypesthesia
Hydrocephalus
Epidermal Growth Factor Receptor
Neuroglia
Brain Stem
Autopsy
Spinal Cord
Necrosis
Head

Keywords

  • Glioblastoma
  • Medulloblastoma
  • Molecular genetics
  • Neoplasm recurrence
  • Radiation-induced neoplasms

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Clinical Neurology

Cite this

Martin, S. E., Brat, D. J., Vance, G., Stohler, R., Choi, H., Douglas-Akinwande, A. C., & Hattab, E. M. (2012). Glioblastoma occurring at the site of a previous medulloblastoma following a 5-year remission period. Neuropathology, 32(5), 543-550. https://doi.org/10.1111/j.1440-1789.2011.01277.x

Glioblastoma occurring at the site of a previous medulloblastoma following a 5-year remission period. / Martin, Sarah E.; Brat, Daniel J.; Vance, Gail; Stohler, Ryan; Choi, Haki; Douglas-Akinwande, Annette C.; Hattab, Eyas M.

In: Neuropathology, Vol. 32, No. 5, 10.2012, p. 543-550.

Research output: Contribution to journalArticle

Martin, SE, Brat, DJ, Vance, G, Stohler, R, Choi, H, Douglas-Akinwande, AC & Hattab, EM 2012, 'Glioblastoma occurring at the site of a previous medulloblastoma following a 5-year remission period', Neuropathology, vol. 32, no. 5, pp. 543-550. https://doi.org/10.1111/j.1440-1789.2011.01277.x
Martin, Sarah E. ; Brat, Daniel J. ; Vance, Gail ; Stohler, Ryan ; Choi, Haki ; Douglas-Akinwande, Annette C. ; Hattab, Eyas M. / Glioblastoma occurring at the site of a previous medulloblastoma following a 5-year remission period. In: Neuropathology. 2012 ; Vol. 32, No. 5. pp. 543-550.
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