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[The fulminant meningeosis blastomatosa of a medulloblastoma during postoperative chemotherapy].

BACKGROUND
Chemotherapy is currently investigated in young children with medulloblastoma with the objective to omit or even delay craniospinal irradiation.


CASE REPORT
We report a case of very early meningeal progression of medulloblastoma during postoperative chemotherapy in a 2.5-year-old boy. At 2 3/12 years of age, the boy developed ataxia. One month later, a malignant cerebellar tumor was diagnosed by magnetic resonance tomography. The boy underwent a macroscopically complete resection. Histological diagnosis revealed medulloblastoma. Postoperative magnetic resonance scans showed no residual disease or spinal seedings and the patient was classified as T3 M0 according to Chang. Three weeks after surgery, chemotherapy with ifosfamide, VP 16, and methotrexate was started. One month later, a positive Babinski sign developed, computed tomography scans showed no abnormalities. Chemotherapy was continued with cisplatin plus cytosine arabinoside as well as cisplatin plus ifosfamide and methotrexate. After 4 months of chemotherapy, a seizure and weakness of the legs occurred. Magnetic resonance scans revealed massive meningeal seeding and 400 tumor cells/microliters were found in the cerebrospinal fluid. Craniospinal irradiation was initiated, and the neurologic symptoms resolved. The boy died, however, 4 months later due to progressive spinal disease.


CONCLUSIONS
The early and rapid meningeal progression during chemotherapy is uncommon. The case demonstrates the difficulties of diagnosis and differential diagnosis.