Abstract
Abstract
Background
Craniospinal irradiation (CSI) for pediatric medulloblastoma improves survival but is associated with an increased risk of radiation-induced second primary neoplasms (SPNs), which can be difficult to distinguish from tumor recurrence.
Case presentation
We report a 14-year-old male treated with surgery, CSI, and chemotherapy for desmoplastic/nodular medulloblastoma (WHO grade IV), whose treatment course was complicated by pulmonary tuberculosis requiring temporary interruption of therapy. After six years of disease-free follow-up, he developed new neurological symptoms; imaging revealed a contralateral posterior fossa lesion, and histopathology confirmed a histologically distinct WHO grade III astrocytoma, consistent with a second primary neoplasm rather than recurrence. Despite gross total resection, the patient experienced rapid neurological deterioration and died of infectious and systemic complications.
Conclusions
This case highlights the risk of radiation-induced high-grade gliomas in pediatric medulloblastoma survivors and underscores the importance of distinguishing recurrence from a second primary neoplasm, maintaining long-term radiological surveillance, and considering strategies such as proton therapy to reduce late radiation-induced complications.