title: Histopathologic grading of adult medulloblastomas.
abstract: BACKGROUND
  Histopathologic evaluation of the degree and extent of anaplasia is a useful prognostic parameter in pediatric medulloblastomas. Whether the same applies to adult medulloblastomas is not known.
  
  
  METHODS
  The study included 74 adult patients with histologically confirmed medulloblastomas and retrospectively reassessed 67 cases with available slides for the presence of nodularity, collagen deposition (desmoplasia without nodules), and degree and extent of anaplasia.
  
  
  RESULTS
  Patients included 43 men and 31 women with the following age distribution: 18-40 years (84%); 41-50 years (9%); and 51-70 years (7%). At last follow-up, 56 patients were alive with a mean follow-up of 6.3 years (range, 0.1-20.8 years). A variety of treatments were employed during the study period, including postoperative radiation (85%) and chemotherapy (27%). Precise treatment modalities were unknown in 12% of patients. Anaplasia was absent (34%), mild (34%), moderate (27%), or severe (5%). Severe anaplasia was diffuse in 2 cases and focal in 1, although in the latter cases severe anaplasia was diffusely present at the time of disease recurrence. Male sex was associated with decreased 10-year recurrence-free survival (40% vs 66%; P = .021) and overall survival (38% vs 68%; P = .005). Severe anaplasia at first resection was found to be an independent predictor of decreased recurrence-free survival (P = .005) and overall survival (P = .015).
  
  
  CONCLUSIONS
  The incidence of severe anaplasia in adult medulloblastomas is lower than in the pediatric population. Male sex and the presence of severe anaplasia at the time of first resection are predictors of decreased recurrence-free and overall survival. However, the significance of severe anaplasia should be regarded with caution based on the small number of tumors with this feature in the current study.
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: Fausto J
authors.initials: FJ
authors.lastname: Rodriguez
authors.forename: Charles
authors.initials: C
authors.lastname: Eberhart
authors.forename: Brian Patrick
authors.initials: BP
authors.lastname: O'Neill
authors.forename: Jeff
authors.initials: J
authors.lastname: Slezak
authors.forename: Peter C
authors.initials: PC
authors.lastname: Burger
authors.forename: Patricia
authors.initials: P
authors.lastname: Goldthwaite
authors.forename: Wenting
authors.initials: W
authors.lastname: Wu
authors.forename: Caterina
authors.initials: C
authors.lastname: Giannini
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002528:Cerebellar Neoplasms / Q000145:classification* / Q000473:pathology; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D008297:Male; D008527:Medulloblastoma / Q000145:classification* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D017678:Sex Distribution; D015996:Survival Rate