Medulloblastoma in two successive pregnancies. Albiruni Ryan Abdul Razak1, Qasiem Nasser1, Patrick Morris1, David Alcutt2 and Liam Grogan1. 1Department ...
Ó Springer 2005
Journal of Neuro-Oncology (2005) 73: 89–90 DOI 10.1007/s11060-004-4209-2
Letter to the Editor
Medulloblastoma in two successive pregnancies Albiruni Ryan Abdul Razak1, Qasiem Nasser1, Patrick Morris1, David Alcutt2 and Liam Grogan1 1 Department of Medical Oncology, Beaumont Hospital, Dublin, Ireland; 2Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
Key words: medulloblastoma, pregnancy, recurrent Summary A 24-year old primaparous female at 20 weeks gestation presented acutely with cerebellar symptoms. Magnetic resonance imaging brain showed evidence of a cerebellar vermis lesion. This was diagnosed as medulloblastoma on histopathological analysis. She underwent surgical debulking and radiotherapy. Interestingly, the lesion recurred 4 years later on her second pregnancy. She underwent further surgical debulking and adjuvant chemotherapy. We believe this is the first reported description of recurrent medulloblastoma in successive pregnancies. A brief discussion on this disease and its management in pregnancy setting is also presented.
Case We present the case of a 24-year old woman, who at 26weeks gestation of her first pregnancy was admitted with a 4-week history of severe occipital headache, ataxia, double vision and photophobia. On examination, papilloedema, impaired co-ordination associated with a cerebellar ataxic gait was observed. Magnetic resonance imaging (MRI) brain demonstrated a large posterior fossa tumour of the cerebellar vermis (Figure 1). (MRI) of the neuroaxis was normal. The patient underwent surgical resection and histology showed evidence of small rounded blue malignant cells consistent with medulloblastoma (Figure 2). Post-operative MRI indicated presence of residual disease, which necessitated a second surgical debulking. She underwent an elective caesarean section at 30 weeks gestation to a healthy live born baby girl. The patient then underwent craniospinal axis radiotherapy, 35 Gy in 25 fractions with additional 20 Gy in 12 fractions to the tumour bed. Post-treatment, complete response was demonstrated. The patient remained well with evidence of complete response based on restaging MRI. Four years later, at 26 weeks gestation of her second pregnancy, she represented with a 3 weeks history of occipital headache associated with deterioration of her hand writing. MRI brain showed a large tumour in relation to the cerebellar vermis. MRI spine showed no evidence of tumour seeding. A repeat biopsy confirmed recurrence of the medulloblastoma. Subsequent immunohistochemistry profile for oestrogen, progesterone receptor and b-HCG in both tumour samples were negative. The patient underwent emergency debulking and excision surgery of the tumour. Elective caesarean section, delivering a healthy baby boy was carried out at 30 weeks gestation. Two weeks post-delivery, adjuvant chemotherapy was commenced. The P6 regimen, which is a well known
protocol for the treatment of primitive neuroectodermal tumours and Ewing’s sarcoma was used [1,2]. Post-chemotherapy, restaging MRI showed complete response.
Discussion Medulloblastomas are rare in adults, accounting for
