Very late frontal relapse of medulloblastoma mimicking a meningioma in an adult: usefulness of 1H magnetic resonance spectroscopy and diffusion-perfusion magnetic resonance imaging for preoperative diagnosis: case report.

摘要: Objective and importance We present a rare case of very long-term medulloblastoma relapse in an adult patient discuss the pattern recurrence metabolic imaging tumor. Clinical presentation A 45-year-old man was referred for evaluation frontobasal midline tumor 21 years after treatment cerebellar by surgery followed chemotherapy craniospinal radiotherapy. Magnetic resonance images were suggestive meningioma. Several hypotheses discussed, such as other radio-induced tumors, sarcomas, high-grade gliomas, or lymphomas (previous chemotherapy) even medulloblastoma. Preoperative exploration included H magnetic single-voxel spectroscopy (35 135 ms echo time), diffusion imaging, perfusion imaging. Intervention On spectroscopy, N-acetyl-aspartate elevated choline/creatine ratio retrieved, with huge unidentified peak at 1.27 parts per million (ppm). Myoinositol signal both times. appeared hyperintense, low apparent coefficient value 0.689. In study, maximal relative cerebral blood volume 2. Metabolic favored diagnosis over initially suspected The underwent complete removal that confirmed to be metastasis his primary postoperative course uneventful, complementary courses radiotherapy planned. Conclusion Late should considered, several decades, on occurrence second intracranial this context. Our observation validates clinical interest preoperative brain tumors distinctive pattern.