The Neuroradiology Journal 19: 799-803, 2006 www. centauro. it 799 Extracentral Nervous System Metastases from Medulloblastoma A Case Report S. BATTAGLIA, A.F. MARLIANI, A. STAFA, E. FRANCESCHI*, R. AGATI Neuroradiology Department, * Oncological Department, Bellaria Hospital; Bologna Italy Key words: medulloblastoma, vertebral metastases, MRI Case Report A 30-year-old woman underwent apparently radical resection of a tumour located in the su- peromedial third of the right cerebellar hemi- sphere in February 2005. Histological exami- nation classified the tumour as a neuroblastic medulloblastoma. During the same operation external ventricu- lar drainage was inserted for tumour-induced hydrocephalus and subsequently removed. MR examination of the whole neural axis and CSF analysis were normal. The patient received ra- diotherapy to the brain and spine in the follow- ing months. After being well for more than a year, the pa- tient presented legs pain associated with bilat- eral paraesthesias. Neurological examination was normal. On that occasion MR investigation of the neural axis using a 1.5 Tesla Signa Infin- ity EchoSpeed system (General Electric Medi- cal Systems, Milwakee, Wisconsin) ruled out tumour recurrence in the posterior fossa (fig- ure 1), but disclosed multiple inhomogeneous signal changes in all sequences in the spine, mostly caused by metastases without vertebral collapse and to a lesser extent by radiotherapy- induced fatty degeneration (figure 2 A, B). No leptomeningeal seeding was found (figure 3). Cytological examination of the CSF failed to reveal tumour cells. SUMMARY – Medulloblastoma belongs to the group of highly malignant neuroepithelial tumours and is the commonest tumour in childhood (12-25 %) 1 , but is rare in adults (0.4-1%) of all pri- mary brain tumours) 1,2 . Medulloblastomas usually arise in the posterior fossa and spread readily throughout the CSF, although 10-30% of patients develop extracentral nervous system metastases 2 . We describe a 30-year-old woman presenting bone metastases from medulloblastoma located pre- dominantly in the spine. Total body bone scintigraphy using 740 MBq Tc 99m oxidronate showed diffusely increased skeletal uptake of the tracer, especially in the pelvis, proximal humeri and proximal and dis- tal femurs. X-ray of the pelvis, humeri, femurs and dorsolumbar spine confirmed some of the bone thickening lesions (figure 4 A, B), which were responsible of legs pain. A diagnosis of metastases from medullob- lastoma was established because extraneural lesions were found without other primary tu- mours, in agreement with Kochbati 3 . The patient is currently receiving five cycles of chemotherapy (etoposide, cyclophosphamide and platinum). MR follow-up scan of the whole spine after five months of treatment (October 2006) failed to disclose significant changes. Discussion Medulloblastoma mainly spreads throughout the CSF often seeding to the leptomeninges with metastases already present in 33% of pa- tients at the time of diagnosis 1 , predominantly located in the spine. Tumour seeding to the abdominal cavity is common when a ventriculo-peritoneal shunt has been inserted (20%) 1,4,5 . Extracentral nerv- ous system metastases are rare in both children and adults (10-30 % of patients) 2 . Secondary le-