title: Large cell anaplastic medulloblastoma metastatic to the scalp: tumor and derived stem-like cells features.
abstract: BACKGROUND
  Extraneural metastases (ENM) rarely occur in medulloblastoma (MBL) patients and only few cases of subcutaneous localizations have been described. ENM indicate an aggressive disease associated with a worse prognosis. The characterization of metastatic tumours might be useful to understand their pathogenesis and to identify the most appropriate therapeutic strategies.
  
  
  METHODS
  We present the case of a child with Large Cell Anaplastic (LC/A) MBL, who developed multiple subcutaneous metastases in the scalp area after a ventriculo-peritoneal shunting procedure. The disease rapidly progressed and the child died despite chemotherapy and primary tumour surgical debulking.We molecularly classified the tumour as a group 3 MBL; in addition, we derived stem-like cells (SLC) from a metastatic lesion. Primary tumour, metastases and SLC were further analysed, particularly focusing on features linked to the cutaneous dissemination. Indeed, molecules involved in angiogenesis, cell invasion and epidermal growth factor signalling resulted highly expressed.
  
  
  CONCLUSIONS
  The present report describes a very rare case of subcutaneous metastatic MBL. The tumour, metastases and SLC have been clinically, pathologically and molecularly characterized. Our case is an example of multidisciplinary approach aiming to characterize MBL aggressive behaviour.
authors.forename: Angela
authors.initials: A
authors.lastname: Mastronuzzi
authors.forename: Evelina
authors.initials: E
authors.lastname: Miele
authors.forename: Agnese
authors.initials: A
authors.lastname: Po
authors.forename: Manila
authors.initials: M
authors.lastname: Antonelli
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Buttarelli
authors.forename: Giovanna Stefania
authors.initials: GS
authors.lastname: Colafati
authors.forename: Francesca
authors.initials: F
authors.lastname: del Bufalo
authors.forename: Roberta
authors.initials: R
authors.lastname: Faedda
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Spinelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Carai
authors.forename: Felice
authors.initials: F
authors.lastname: Giangaspero
authors.forename: Alberto
authors.initials: A
authors.lastname: Gulino
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Department of Molecular Medicine, Sapienza University, Viale Regina Elena 291, 00161 Rome, Italy. elisabetta.ferretti@uniroma1.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ferretti
mesh_terms: D002675:Child, Preschool; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D009362:Neoplasm Metastasis / Q000235:genetics* / Q000473:pathology; D014411:Neoplastic Stem Cells / Q000473:pathology*; D011379:Prognosis
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