Post-radiation cranial fasciitis in a pediatric medulloblastoma survivor: A case report and systematic review

TL;DR

This paper reports a rare case of cranial fasciitis in a child who had medulloblastoma and highlights the importance of early diagnosis to avoid unnecessary treatments.

Contribution

The study adds a new case of post-radiation cranial fasciitis and emphasizes its distinction from malignancies through histopathological confirmation.

Findings

Post-radiation cranial fasciitis can mimic malignancy but is benign and curable with surgical excision.

Complete surgical removal of the lesion resulted in no recurrence at six-month follow-up.

Early diagnosis is crucial to prevent unnecessary treatments in pediatric survivors of brain tumors.

Abstract

Cranial fasciitis (CF) is a rare, benign fibroproliferative lesion primarily affecting children. Post-radiation CF is particularly uncommon, and has been reported in only seven previous cases. Its presentation often mimics malignancy, with nonspecific preoperative findings complicating the diagnosis, therefore necessitating early intervention.

We report a 12-year-old male with a history of medulloblastoma treated with chemoradiotherapy four years ago, who presented with a progressive right temporo-occipital scalp mass. Imaging showed an extradural mass with calvarial bone erosion. Complete surgical excision was performed, and histopathology confirmed CF. No recurrence was observed at six-month follow-up.

Post-radiation CF is an extremely rare complication of radiotherapy. Due to its rapid growth, bony invasion, and occasional intracranial extension, it can be misdiagnosed as a radiation-induced neoplasm. Given the overlap in clinical and radiologic features with malignancies such as meningioma or sarcoma, histopathological confirmation is essential. Unlike neoplasms, CF follows a benign course, and complete surgical excision is often curative.

Post-radiation CF should be considered in children with prior radiotherapy presenting with scalp masses. Early diagnosis and surgical intervention are crucial for avoiding unnecessary treatments and ensuring favorable outcomes.

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•Cranial fasciitis can develop as a rare complication of radiotherapy in pediatric brain tumor survivors•Post-radiation cranial fasciitis mimics malignancy with potential transcranial extension and bone erosion•Complete surgical excision in most cases is curative with excellent prognosis despite aggressive appearance•Early diagnosis prevents unnecessary treatments in this benign fibroproliferative lesion

Cranial fasciitis can develop as a rare complication of radiotherapy in pediatric brain tumor survivors

Post-radiation cranial fasciitis mimics malignancy with potential transcranial extension and bone erosion

Complete surgical excision in most cases is curative with excellent prognosis despite aggressive appearance

Early diagnosis prevents unnecessary treatments in this benign fibroproliferative lesion

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