Medulloblastoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]

Overview

Medulloblastoma arises from cerebellar stem cells, which are normally involved in the anatomical development of the cerebellum and other posterior fossa structures.^[1]
Medulloblastoma is usually located at the infratentorial region, where it forms a mass between the brain stem and the cerebellum in the vicinity of the fourth ventricle.^[1]
Medulloblastoma is an invasive and rapidly growing tumor.^[1]
Unlike most brain tumors, medulloblastoma may spread through the cerebrospinal fluid (CSF) and frequently metastasize to different organs of the body.^[1]
Medulloblastoma is often associated with gorlin syndrome and turcot syndrome.^[1]

The progression to medulloblastoma usually involves the P53 molecular pathway.^[1]

On gross pathology, a pink, solid, and well circumscribed mass is a characteristic finding of medulloblastoma.^[1]
The following image demonstrates the gross pathology observed in medulloblastoma:

Image courtesy of Dr Frank Gaillard Radiopaedia(original file "here"). Creative Commons BY-SA-NC

On microscopic histopathological analysis, round tumor cells, elevated mitotic rate, increased nucleus:cytoplasm ration, and presence of Homer-Wright rosettes are characteristic findings of medulloblastoma.
Shown below is a series of microscopic images observed in medulloblastoma:

Medulloblastoma smear^[2]
Medulloblastoma smear ^[2]
Medulloblastoma smear demonstrating Homer-Wright rosettes^[2]
Medulloblastoma smear demonstrating cerebellar infiltrative growth^[2]
Medullloblastoma smear demonstrating demsomplastic nodular growth^[2]
Anaplastic large cell medulloblastoma smear^[2]
Medulloblastoma smear^[2]
Desmoplastic medulloblastoma smear on reticulin stain demonstrating "pale islands"^[2]
Desmoplastic medulloblastoma on MIB-1 immunostaining^[2]
Medulloblastoma smear demonstrating areas of geographic necrosis^[2]
Medulloblastoma smear demonstrating epitheloid ribboning and nuclear moulding of tumor cells^[2]
Medulloblastoma smear demonstrating partial MAP2 immunoreactivity^[2]