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Washington University Experience | NEOPLASMS (EMBRYONAL) | Medulloblastoma, Histologically Defined | Large cell-Anaplastic (LCA) | 6E Case 6 Denouement
Final Neuropathologic Diagnoses ---- LC/A Medulloblastoma, cerebellar vermis with extensive subarachnoid spread; Moyamoya syndrome, angiographically proven; Infarcts, recent and resolving, involving left and right frontal lobes, temporal and occipital lobes, left and right basal ganglia. ---- Comment: Neuropathologic examination of the CNS revealed a medulloblastoma located in the cerebellar vermis with extensive spread throughout the subarachnoid space and into the brain parenchyma. The existence of occasional thin-walled vessels and admixed tumor from the base of the brain, adventitial growth of tumor involving multiple vessels from the circle of Willis, potential intravascular tumor emboli, and focal intimal thickening involving multiple vessels suggest the neoplasm and vascular changes may be related. In addition, a possible tumor blush in tumor at the base of the brain may have contributed to the radiographic Moyamoya appearance. The precise scenario resulting in the development of multiple areas of infarction is unclear. Superimposition of systemic hypotension or hypoxia in the presence of vasculopathy as well as involvement in areas unsampled at autopsy (e.g., internal carotid arteries) may have resulted in the extensive infarction which represented the most immediate cause of death in this patient. Although there is focal and mild thickening of the intima of these basal vessels in areas associated with areas of intravascular tumor, frank unequivocal tumor thrombotic occlusion is not seen.
