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Multi-modality therapy has led to significant improvement in outcomes for childhood medulloblastoma; however, long-term survivors have become more susceptible to late effects of therapy including induction of second malignant neoplasms and even remain at an increased risk of late relapses including extra-neuraxial metastases. A newly detected solitary lytic/sclerotic osseous lesion in a medulloblastoma survivor away from the radiation field poses considerable diagnostic challenge as it could represent either a second malignant neoplasm or extra-neuraxial metastasis. We report one such case highlighting the importance of contemporary pathology techniques as useful adjuncts to differentiate a second primary osseous Ewing ’s sarcoma (ES)/primitive neuro-ectodermal tumor (PNET) from bony metastasis and review the pertinent literature on second malignant neoplasms and extra-neuraxial metastases in medulloblastoma. To the best of our knowledge, this is the first report of a molecularly confirmed second primary osseous ES/PNET in a survivor of childhood medulloblastoma. DOI : 10.14302/issn.2576-182X.jbsc-14-576 Corresponding author: Dr Tejpal Gupta, MD, DNB, Associate Professor, Radiation Oncology ACTREC, Tata Memorial Centre, Kharghar, Navi Mumbai: 410210, INDIA Tele: 91-22-27405057 and Fax: 91-22-27405061 E-mail: tejpalgupta@rediffmail.com

journal of brain and spinal cancer

Newly-detected solitary bony lytic/sclerotic lesion with soft tissue mass in a previously treated case of high-risk medulloblastoma: importance of contemporary pathology techniques to differentiate second malignant neoplasm from extra-neuraxial metastasis