title: A medulloblastoma showing an unusually long doubling time: reflection of its singular nature.
abstract: METHODS
  In this paper, we present a case of a 4-year-old male diagnosed with a desmoplastic, SHH-type medulloblastoma. Retrospectively, we discovered that the patient underwent an MRI scan at 21 months for reasons unrelated, revealing a T1-enhanced lesion at the vermis, later recognized as the source of the tumor. This unique case provides us with a glimpse into the natural history of this tumor. Our ability to measure tumor volume at two defined time points, 31 months apart, enabled us to deduce the tumor's doubling time. This is defined as the time of one cell cycle divided by the amount of cycling cells, multiplied by cell loss factor. Potential doubling time (Tpot) and actual doubling time (Td), calculated using the Gompertzian model, are the most clinically relevant with regard to a tumor's response to radiotherapy. Here, we show an actual doubling-time (Td) of 78 days, and an extrapolated tumor diameter at the time of birth of 0.25 mm.
  
  
  CONCLUSIONS
  These results both support the medulloblastoma's embryonic origin, and indicating a threefold longer actual doubling time when compared to previous studies. Taking into account the reported range of medulloblastoma potential doubling time, we deduced a cell loss factor of between 48.9 and 95.5 %. These percentages fall in line with other malignant tumors. Although limited due to the obvious reliance on only two points in time and using the Gompertzian model to complete the remainder, to the best of our knowledge, this is the longest follow-up period reported for medulloblastoma. We have described how a unique turn of events enabled us to get a glimpse into the in situ development of a medulloblastoma over a 31-month period. Regarded sometimes as an idiosyncratic tumor comprised of an array of molecular changes, the complexity of medulloblastoma is displayed here, by revealing for the first time an actual doubling time three- to fourfold the previously known length.
authors.affiliation: Department of Neurosurgery, Sheba Tel-Hashomer Hospital, Affiliated to Tel Aviv University Sackler Medical School, Sheba Rd. 2, Ramat-Gan, Israel. omerdoronmd@gmail.com.
authors.forename: Omer
authors.initials: O
authors.lastname: Doron
authors.affiliation: Department of Neurosurgery, Sheba Tel-Hashomer Hospital, Affiliated to Tel Aviv University Sackler Medical School, Sheba Rd. 2, Ramat-Gan, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Zauberman
authors.affiliation: Department of Neurosurgery, Sheba Tel-Hashomer Hospital, Affiliated to Tel Aviv University Sackler Medical School, Sheba Rd. 2, Ramat-Gan, Israel.
authors.forename: Ze'ev
authors.initials: Z
authors.lastname: Feldman
mesh_terms: D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging; D002675:Child, Preschool; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000000981:diagnostic imaging; D013997:Time Factors
keywords: Doubling time; Gompertzian model; Medulloblastoma; Pediatric neurosurgery