Medulloblastoma Associated with Down Syndrome: From a Rare Event Leading to a Pathogenic Hypothesis

• Published in: Diagnostics (Basel) Vol. 11; no. 2; p. 254
• Main Authors: Boni, Alessandra, Ranalli, Marco, Del Baldo, Giada, Carta, Roberto, Lodi, Mariachiara, Agolini, Emanuele, Rinelli, Martina, Valentini, Diletta, Rossi, Sabrina, Alesi, Viola, Cacchione, Antonella, Miele, Evelina, Alessi, Iside, Caroleo, Anna Maria, Colafati, Giovanna Stefania, De Ioris, Maria Antonietta, Boccuto, Luigi, Balducci, Mario, Carai, Andrea, Mastronuzzi, Angela
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 07.02.2021; MDPI
• Subjects: Brain cancer; brain tumor; cancer predisposition syndrome; Case Report; Chromosomes; Cloning; Cognitive ability; Deoxyribonucleic acid; DNA; DNA methylation; Down syndrome; Genes; Hearing loss; Kinases; Leukemia; Magnetic resonance imaging; medulloblastoma; Mutation; Nervous system; Patients; Pediatrics; Population; Proteins; Tumors; brain tumor; Down syndrome; medulloblastoma; cancer predisposition syndrome
• DOI: 10.3390/diagnostics11020254
• ISSN: 2075-4418

Down syndrome (DS) is the most common chromosome abnormality with a unique cancer predisposition syndrome pattern: a higher risk to develop acute leukemia and a lower incidence of solid tumors. In particular, brain tumors are rarely reported in the DS population, and biological behavior and natural history are not well described and identified. We report a case of a 10-year-old child with DS who presented with a medulloblastoma (MB). Histological examination revealed a classic MB with focal anaplasia and the molecular profile showed the presence of a variant associated with the wingless (WNT) molecular subgroup with a good prognosis in contrast to our case report that has shown an early metastatic relapse. The nearly seven-fold decreased risk of MB in children with DS suggests the presence of protective biological mechanisms. The cerebellum hypoplasia and the reduced volume of cerebellar granule neuron progenitor cells seem to be a possible favorable condition to prevent MB development via inhibition of neuroectodermal differentiation. Moreover, the NOTCH/WNT dysregulation in DS, which is probably associated with an increased risk of leukemia, suggests a pivotal role of this pathway alteration in the pathogenesis of MB; therefore, this condition should be further investigated in future studies by molecular characterizations.