Delayed incision tract medulloblastoma metastasis in an adul
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Case Summary
A 42-year-old man initially presented to the emergency room with a 6-month history of gradually worsening lethargy, dizziness, imbalance, confusion, short-term memory loss, intermittent headaches, and worsening slurred speech. He was subsequently diagnosed with cerebellar medulloblastoma and had a subtotal tumor resection followed by craniospinal radiation. He suffered severe radiation toxicity and did not receive chemotherapy. Follow-up craniospinal imaging has been negative for recurrence; however, he is now presenting 3 years later with a palpable subcutaneous nodule in the nuchal soft tissues near the inferior border of the old nuchal incision scar.

Imaging Findings
MRI of the neck without and with contrast revealed a well-circumscribed posterior midline subcutaneous mass at the inferior aspect of the healed incision measuring 2.2 cm by 1.7 cm transaxially. The mass demonstrated homogeneous T1 and T2 prolongation and enhancement following the administration of Magnevist intravenous contrast (Figures 1-3). Additionally, the mass had mild diffusion restriction. The mass was approximately 1 cm deep to the skin and abutted the superficial muscular fascia. A PET-CT performed after resection of the nodule demonstrated no additional metastatic disease; however, no pre-operative PET imaging was performed.

Conclusion
Subcutaneous incision tract metastatic medulloblastoma confirmed pathologically

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