Medulloblastoma is a malignant cerebellar tumor seen primarily in the pediatric age group that has a known ability to metastasize extraneurally. The skeleton is the most common site of extraneural metastases, but metastases to the bone marrow can also occur. Four cases of medulloblastoma metastatic to the marrow are reported. In addition, 31 cases from the medical literature are reviewed. Clinical features include bone tenderness, cytopenias and elevated serum alkaline phosphatase and lactic dehydrogenase levels. Skeletal involvement, especially of the pelvic bones, is frequently seen radiographically. Weight loss, soft tissue masses and a requirement for blood transfusion are also associated features. Marrow biopsy specimens are characterized by the presence of a small cell tumor often with fibrosis, necrosis and osteoblastic activity. The symptomatic response to chemotherapy is rapid, but chemotherapy resistance appears quickly. Only 1 in 4 cases diagnosed antemortem in this review lived for more than a year. We conclude that marrow aspiration and biopsy are indicated in the evaluation of patients with medulloblastoma and may serve to diagnose the cause of cytopenias, to verify extraneural spread and to provide prognostic information.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Nelson AA: Metastases of intracranial tumors. Am J Cancer 28:1–12, 1936.
Kehler WH, Beck E: Cerebellar sarcoma with bone metastases. Radiology 63:736–740, 1954.
Rubinstein LJ: Extracranial metastases in cerebellar medulloblastoma. J Path Bact 78:187–195, 1959.
Paterson E: Distant metastases from medulloblastoma of the cerebellum. Brain 84:301–309, 1961.
Drachman DA, Winter TS III, Karom M: Medulloblastoma with extracranial metastases. Arch Neurol 9:518–530, 1963.
Oberman HA, Hewitt WC, Kalivoda AJ: Medulloblastoma with distant metastases. Am J Clin Pathol 39:148–160, 1963.
Miyake S, Toyama M, Etani B, Fukuma S: Cerebellar medulloblastoma with postoperative extracranial spread. Report of a case. J Neurosurg 21:416–418, 1964.
Rubinstein LJ, Northfield DW: Medulloblastoma and the so-called ‘arachnoidal cerebellar sarcoma’; critical re-examination of a nosological problem. Brain 87:379–412, 1964.
Corrin B, Meadows JC: Skeletal metastases from cerebellar medulloblastoma. Br Med J 2:485–486, 1967.
Bach M, Simpson WJ, Platts ME: Metastatic cerebellar sarcoma (desmoplastic medulloblastoma) with diffuse osteosclerosis and leukoerythroblastic anemia. A report of a case and review of the literature. Am J Roentgen Rad Ther Nucl Med 103:38–43, 1968.
Lewis MB, Nunes LB, Powell DE, Shnider BI: Extracranial spread of medulloblastoma. Cancer 31:1287–1297, 1973.
Gunasekere WS, Cabraal SA: Extraneural metastases of intracranial tumors. Neurol India 21:200–205, 1973.
Crist WM, Ragab AH, Vietti TJ, Ducos R, Chu J-Y: Chemotherapy of childhood medulloblastoma. Am J Dis Child 130:639–642, 1976.
Nathanson L, Kovacs SG: Chemotherapeutic response in metastatic medulloblastoma. Report of two cases and a review of the literature. Med Pediatr Oncol 4:105–110, 1978.
Packert RC, Farr GH Jr: Medulloblastoma metastatic to bone. Clin Bulletin 8:38–40, 1978.
Chu, J-Y: Metastatic medulloblastoma simulating acute leukemia. J Pediatr 94:921–923, 1979.
Courtney JV, Kelleher J, Radkowski MA: Skeletal metastases from medulloblastoma. Ir J Med Sci 148:189–191, 1979.
Duffner PK, Cohen ME: Extraneural metastases in childhood brain tumors. Ann Neurol 10:261–265, 1981.
Kleinman GM, Hochberg FH, Richardson EP Jr: Systemic metastases from medulloblastoma: Report of two cases and review of the literature. Cancer 48:2296–2309, 1981.
Pollak ER, Miller HJ, Vye MV: Medulloblastoma presenting as leukemia. Am J Clin Pathol 76:98–103, 1981.
Allen JC, Helson L: High-dose cyclophosphamide chemotherapy for recurrent CNS tumors in children. J Neurosurg 55:749–756,1981.
Lowery GS, Kimball JC, Patterson RB, Raben M: Extraneural metastases from cerebellar medulloblastoma. Am J Pediatr Hematol/Oncol 4:259–262, 1982.
Levin VA, Vestnys PS, Edwards MS, Wara WM, Fulton D, Barger G, Seager M, Wilson CB: Improvement in survival produced by sequential therapies in the treatment of recurrent medulloblastoma. Cancer 51:1364–1370, 1983.
McComb JG, Davis RL, Isaacs H Jr: Extraneural metastatic medulloblastoma during childhood. Neurosurg 9:548–550, 1981.
Morild I, Mork S. Nyland H: Metastasizing neuroectodermal tumour. Neurol 227:151–155, 1982.
Ho EP, Lieber A, DeLand FH, Maryama Y: Generalized osteoblastic bony metastases from medulloblastoma. Oncology 33:253–256, 1976.
Park TS, Hoffman HJ, Hendrick EB, Humphreys RP, Becker LE: Medulloblastoma: clinical presentation and management. J Neurosurg 58:543–552, 1983.
Finklestein JZ, Lemperer MR, Evans A, Bernstein I, Leikin S, McCreadie S, Grosfeld J, Hittle R, Weiner J, Sather H, Hammond D: Multiagent chemotherapy for children with metastatic neuroblastoma: A report from Childrens Cancer Study Group. Med Pediatr Oncol 6:179–188, 1979.
Mackay B, Luna MA, Butler JJ: Adult neuroblastoma. Electron microscopic observations in nine cases. Cancer 37:1334–1351,1975.
Liwnicz BH, Rubinstein LJ: The pathways of extraneural spread in metastasizing gliomas. A report of three cases and critical review of the literature. Hum Pathol 10:453–467, 1979.
About this article
Cite this article
Spencer, C.D., Weiss, R.B., Van Eys, J. et al. Medulloblastoma metastatic to the marrow. J Neuro-Oncol 2, 223–235 (1984). https://doi.org/10.1007/BF00253274
- metastatic medulloblastoma
- bone marrow