Primary glioblastoma of the cerebellar vermis: A case report

Abstract

Cerebellar glioblastoma is a rare adult tumor. The accurate diagnosis of cerebellar glioblastoma is important for establishing a suitable therapeutic schedule. However, it is occasionally difficult to diagnosis these tumors. Clinical presentation, computed tomography (CT) and magnetic resonance imaging can provide useful information, but they may not lead to a definitive diagnosis. Positron emission tomography/computed tomography (PET/CT) may provide a novel way of forming a differential diagnoses. The lesions of glioblastoma multiforme (GBM) rarely occur in the cerebellum, with prior studies reporting that only 0.4-3.4% of all GBM tumors occur here. In the current study, a case of primary cerebellar glioblastoma is presented and the physiopathology, clinical presentation, diagnosis, differential diagnosis, treatment and general outcome of this disease are discussed. A 61-year-old female presented with nausea, vomiting, balance problems and cerebellar signs. Cranial magnetic resonance imaging (MRI) and positron emission tomography/computed tomography (PET/CT) examination demonstrated one regular contour of a mass lesion in the cerebellar vermis. Following surgery, glioblastoma was histologically confirmed. The outcome of the patient was favorable after 18 months of follow-up. Cerebellar GBM should be considered in the differential diagnosis of a cerebellar mass lesion, and PET/CT may provide a novel identification method for different cerebellar mass lesions.

Keywords: cerebellar; fluorodeoxyglucose; glioblastoma; magnetic resonance imaging; positron emission tomography/computed tomography.

Figure 1.

Cranial magnetic resonance imaging showing one lesion in the cerebellar vermis. (A) T1-weighted image showing a well-defined hypointense tumor in the vermis of the cerebellum (arrow). (B) T2-weighted image showing a well-distributed hyperintense lesion without evident surrounding edema (arrow). (C and D) T1-weighted magnetic resonance enhanced images showing a well-defined, ring-enhancing lesion with one additional enhanced nodule (arrow).

Figure 2.

(A) Coronal positron emission tomography (PET) image showing no abnormal glucose uptake. (B) Computed tomography scan showing a round cystic mass with more hypodense expression than normal brain tissue. In addition, there is a hyperdense nodule alongside the mass (arrow). (C and D) In the PET and PET/CT images, the nodule (arrow) shows much higher glucose uptake compared with the surrounding brain tissue.

Figure 3.

Tumor sections showing an intense cellular density and nuclear pleomorphism. (A) The tumor cells are characterized by marked anisokaryosis; the nuclei are larger than normal. The cells have an abundant and eosinophilic cytoplasm. Numerous mitoses are observed. Hematoxylin and eosin stain; (A) ×100 and (B) ×400 magnification.