Medulloblastoma. A report of 201 cases with emphasis on the relationship of histologic variants to survival (original) (raw)

Medulloblastoma has invariably been associated with a poor prognosis. However, it has been shown that such tumors in adults have a slightly better prognosis than in children. We have studied 201 such neoplasms and attempted to correlate survival with several factors. In our series, adults survived longer (average 50 months) than children (average 11 months), and females (average 31 months) slightly longer than males (21 months). Location of the primary tumor was also of significance since patients with neoplasms primarily located in a cerebellar hemisphere showed a better survival (47 months) than those located in the cerebellar midline (17 months). T h e histologic typing of the tumor was also important. Patients with ''desmoplastic" medulloblastomas had an average survival of 51 months, while those with the "classical" medulloblastomas had an average of 18 months only. T h e majority of the desmoplastic neoplasms occurred in adults and in cerebellar hemispheres rather than the midline. Further differentiation within the tumor toward the neuroblastic or the glial lines was evident in 51 neoplasms, and no significant differences in survival were noted among them. Four patients eventually developed extracranial metastases, and two were associated with meningiomas. INCE BAILEY AND CUSHING, IN 1925,s DIS-S tinguished the medulloblastoma as a specific entity, a voluminous literature has accumulated on that subject with about 1,500 cases reported'J.23,27 and at least one book entirely devoted to it." Many authors studied the different factors affecting the prognosis of this neoplasm. These efforts were mainly concentrated on the methods of therapy7J0Jal 20.24.31.32 and age of onset.38.40.41 However, no serious attempts were made to correlate survival data with the morphology of medulloblastoma. In 1964, Rubinstein and Northfield38 subclassified the medulloblastoma into two main categories, the "classical" and the "desmoplastic" with a transitional form. Also, it has been reported that this neoplasm may differentiate into the glial or the neuroblastic line.2J'J1.22.39 The purpose of this paper is to examine the effects of age, sex, location of tumor, and particularly histologic variants on the prognosis of medulloblastoma.