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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Diferencias en la presentaci&#243;n radiol&#243;gica de meduloblastomas en la edad adulta ya han sido publicadas&#44; incluyendo la localizaci&#243;n en los hemisferios cerebelosos con apariencia extra-axial&#46; Presentamos un caso cl&#237;nico en que su localizaci&#243;n es poco frecuente&#58; var&#243;n de 40 a&#241;os de edad que refiere episodios de cefaleas&#44; v&#243;mitos matutinos y dificultades de audici&#243;n en lado izquierdo de 3 semanas de evoluci&#243;n&#46; La TAC y RM cerebral mostraron la existencia de un tumor en &#225;ngulo pontocerebeloso izquierdo&#44; de apariencia extra-axial y que se realzaba homog&#233;neamente con el contraste&#46; Fue intervenido y el tumor macrosc&#243;picamente resecado en su totalidad&#44; a trav&#233;s de una craniectom&#237;a suboccipital izquierda&#46; Su apariencia era de tumor extra-axial&#44; semejando un meningioma&#44; y sin aparente relaci&#243;n con el par&#233;nquima&#46; La anatom&#237;a-patol&#243;gica mostr&#243; que se trataba de un tumor de elevada densidad y compuesto de c&#233;lulas con alto potencial proliferativo&#44; que presentaba una densa malla reticul&#237;nica intercelular&#46; El an&#225;lisis inmunohistoqu&#237;mico evidenci&#243; positividad en la expresi&#243;n a sinaptofisina&#44; enolasa neuronal espec&#237;fica y cromogranina&#46; El diagn&#243;stico histopatol&#243;gico definitivo fue de meduloblastoma desmopl&#225;sico y en base a ello se inici&#243; terapia complementaria&#46; El presente caso cl&#237;nico nos advierte que ante la presentaci&#243;n de un tumor de &#225;ngulo pontocerebeloso&#44; estemos atentos a la posibilidad de que exista una relaci&#243;n con el par&#233;nquima vecino&#44; como si de un tumor exof&#237;tico se tratara&#44; lo que aumenta la variabilidad en el diagn&#243;stico histopatol&#243;gico&#46;</p>"
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        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Differences in the imaging characteristic of adult medulloblastomas have been reported&#44; including involvement of lateral cerebellar hemispheres with an extra-axial appearance&#46; We present a case report of this rare circumstance&#58; a 40-year old man presented with a 3-weeks history of headache&#44; morning vomiting and left hearing difficulties&#46; Magnetic resonance imaging revealed a left cerebellopontine angle &#40;CPA&#41; tumor&#44; like a well circumscribed homogeneously enhancing mass&#46; Through a left suboccipital craniectomy the tumor was totally removed&#46; It presented as a cerebellopontine angle tumor&#44; like a meningioma&#44; and not as an intra-axial tumor&#46; Histological analysis revealed that the tumor was composed of densely packed with highly prolife-rative cells that produce a dense intercellular reticulin fiber network&#46; Inmunohistochemical analysis showed positive expression to synaptophysin&#44; specific neuronal enolase and cromogranin&#46; Histological diagnosis was crucial to define it as a desmoplastic medulloblastoma the present case and to perform postoperative adjuvant therapy&#46; Neurosurgeons should be aware of the possibility that a CPA tumor is of intraaxial origin&#44; because this increase the variability on pathological diagnosis&#46;</p>"
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Vol. 15. Núm. 3.
Páginas 285-289 (enero 2004)
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Vol. 15. Núm. 3.
Páginas 285-289 (enero 2004)
Meduloblastoma de presentación extra-axial en el ángulo pontocerebeloso
Medulloblastoma presenting as an extra-axial tumor in the cerebellopontine angle
Visitas
2368
J.L. Gil-Salú
, F. Rodríguez-Peña, M. López-Escobar
Servicios de Neurocirugía. Hospital Universitario Puerta del Mar. Cádiz
M.J. Palomo*
* Anatomía-Patológica. Hospital Universitario Puerta del Mar. Cádiz
Este artículo ha recibido
Información del artículo
Resumen

Diferencias en la presentación radiológica de meduloblastomas en la edad adulta ya han sido publicadas, incluyendo la localización en los hemisferios cerebelosos con apariencia extra-axial. Presentamos un caso clínico en que su localización es poco frecuente: varón de 40 años de edad que refiere episodios de cefaleas, vómitos matutinos y dificultades de audición en lado izquierdo de 3 semanas de evolución. La TAC y RM cerebral mostraron la existencia de un tumor en ángulo pontocerebeloso izquierdo, de apariencia extra-axial y que se realzaba homogéneamente con el contraste. Fue intervenido y el tumor macroscópicamente resecado en su totalidad, a través de una craniectomía suboccipital izquierda. Su apariencia era de tumor extra-axial, semejando un meningioma, y sin aparente relación con el parénquima. La anatomía-patológica mostró que se trataba de un tumor de elevada densidad y compuesto de células con alto potencial proliferativo, que presentaba una densa malla reticulínica intercelular. El análisis inmunohistoquímico evidenció positividad en la expresión a sinaptofisina, enolasa neuronal específica y cromogranina. El diagnóstico histopatológico definitivo fue de meduloblastoma desmoplásico y en base a ello se inició terapia complementaria. El presente caso clínico nos advierte que ante la presentación de un tumor de ángulo pontocerebeloso, estemos atentos a la posibilidad de que exista una relación con el parénquima vecino, como si de un tumor exofítico se tratara, lo que aumenta la variabilidad en el diagnóstico histopatológico.

Palabras clave:
Meduloblastoma
Tumor de ángulo pontocerebeloso
Tumor exofítico
Cirugía
Metástasis
Abreviaturas:
APC
PACF
Summary

Differences in the imaging characteristic of adult medulloblastomas have been reported, including involvement of lateral cerebellar hemispheres with an extra-axial appearance. We present a case report of this rare circumstance: a 40-year old man presented with a 3-weeks history of headache, morning vomiting and left hearing difficulties. Magnetic resonance imaging revealed a left cerebellopontine angle (CPA) tumor, like a well circumscribed homogeneously enhancing mass. Through a left suboccipital craniectomy the tumor was totally removed. It presented as a cerebellopontine angle tumor, like a meningioma, and not as an intra-axial tumor. Histological analysis revealed that the tumor was composed of densely packed with highly prolife-rative cells that produce a dense intercellular reticulin fiber network. Inmunohistochemical analysis showed positive expression to synaptophysin, specific neuronal enolase and cromogranin. Histological diagnosis was crucial to define it as a desmoplastic medulloblastoma the present case and to perform postoperative adjuvant therapy. Neurosurgeons should be aware of the possibility that a CPA tumor is of intraaxial origin, because this increase the variability on pathological diagnosis.

Key-words:
Medulloblastoma
Cerebellopontine angle tumors
Exophytic tumors
Surgery
Metastases

Artículo

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