title: Anomalous vascularization in a Wnt medulloblastoma: a case report.
abstract: BACKGROUND
  Medulloblastoma is the most common malignant brain tumor in children. To date only few cases of medulloblastoma with hemorrhages have been reported in the literature. Although some studies speculate on the pathogenesis of this anomalous increased vascularization in medulloblastoma, the specific mechanism is still far from clearly understood. A correlation between molecular medulloblastoma subgroups and hemorrhagic features has not been reported, although recent preliminary studies described that WNT-subtype tumors display increased vascularization and hemorrhaging.
  
  
  METHODS
  Herein, we describe a child with a Wnt-medulloblastoma presenting as cerebellar-vermian hemorrhagic lesion. Brain magnetic resonance imaging (MRI) showed the presence of a midline posterior fossa mass with a cystic hemorrhagic component. The differential diagnosis based on imaging included cavernous hemangioma, arteriovenous malformation and traumatic lesion. At surgery, the tumor appeared richly vascularized as documented by the preoperative angiography.
  
  
  CONCLUSIONS
  The case we present showed that Wnt medulloblastoma may be associated with anomalous vascularization. Further studies are needed to elucidate if there is a link between the hypervascularization and the Wnt/β-catenin signaling activation and if this abnormal vasculature might influence drug penetration contributing to good prognosis of this medulloblastoma subgroup.
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy. angela.digiannatale@opbg.net.
authors.forename: Angela
authors.initials: A
authors.lastname: Di Giannatale
authors.affiliation: Department of Neuroscience and Neurorehabilitation, Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Carai
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cacchione
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marrazzo
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.
authors.forename: Vito Andrea
authors.initials: VA
authors.lastname: Dell'Anna
authors.affiliation: Imaging Department, Neuroradiology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.
authors.forename: Giovanna Stefania
authors.initials: GS
authors.lastname: Colafati
authors.affiliation: Department of Laboratories - Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Diomedi-Camassei
authors.affiliation: Center for Life NanoScience@Sapienza, Istituto Italiano di Tecnologia, Viale Regina Elena 291, 00161, Rome, Italy.
authors.forename: Evelina
authors.initials: E
authors.lastname: Miele
authors.affiliation: Department of Molecular Medicine, Sapienza University, Viale Regina Elena 291, 00161, Rome, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Po
authors.affiliation: Department of Molecular Medicine, Sapienza University, Viale Regina Elena 291, 00161, Rome, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ferretti
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.|Department of Pediatric Science, University of Pavia, Viale Brambilla 74, 27100, Pavia, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Locatelli
authors.affiliation: Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Piazza di Sant'Onofrio, 4 - 00165, Rome, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Mastronuzzi
mesh_terms: D002528:Cerebellar Neoplasms / Q000098:blood supply* / Q000150:complications / Q000000981:diagnostic imaging; D002648:Child; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D008527:Medulloblastoma / Q000098:blood supply* / Q000150:complications / Q000000981:diagnostic imaging; D009389:Neovascularization, Pathologic / Q000150:complications / Q000000981:diagnostic imaging; D059906:Neuroimaging; D060449:Wnt Signaling Pathway
keywords: Angiogenesis; Case report; Medulloblastoma; Wnt/β-catenin