Abstract
BackgroundExtraneural and extracranial metastases of glioblastoma (GB) are very rarely reported in the literature. They occur in only 0.2% of all GB patients.Case presentationWe present a 40 year old caucasian male with secondary GB and first diagnosis of an astrocytoma world health organisation (WHO) grade II through stereotactic biopsy in 2006. He presented a new hemiparesis and a progress of the known mass lesion in 2008. Subtotal tumor resection was performed and the histological examination verified a GB. After combined radio- and chemotherapy the adjuvant temozolomide therapy was not started because of non-compliance.In 2011 a second local relapse was resected and 4 month later the patient presented a fast progressing tetraparesis. Cervical CT and MRI scan showed a mass lesion infiltrating the fifth and sixth vertebra with infiltration of the spinal canal and large paravertebral tumor masses. Emergency surgery was performed. By additional screening further metastases were detected in the thoracal and lumbal spine and surprisingly also in the lung and pulmonary lymphnodes. Palliative radio- and chemotherapy of the pulmonal lesions was completed, further antitumor therapy was rejected. The patient died 10 months after diagnosis of the extraneural metastases.ConclusionEspecially young “long-term-survivors” seem to have a higher risk of extraneural metastasis from a GB and appropriate staging should be performed in these cases.
Highlights
Extraneural and extracranial metastases of glioblastoma (GB) are very rarely reported in the literature.They occur in only 0.2% of all GB patients.Case presentation: We present a 40 year old caucasian male with secondary GB and first diagnosis of an astrocytoma world health organisation (WHO) grade II through stereotactic biopsy in 2006
We present a case of a 40 year old patient with first diagnosis of an Astrocytoma World Health Organization (WHO) grade II in 2006, a secondary GB in 2008 and multiple extraneural metastases in 2011
Metastases in many different regions of the body in our patient with a secondary GB, especially the combination of lung and osseous lesions with intraspinal involvement makes this new case in many aspects unique
Summary
Glioblastoma (GB) is known as a highly aggressive neuroepithelial tumor almost exclusively growing in the neural tissue. We present a case of a 40 year old patient with first diagnosis of an Astrocytoma World Health Organization (WHO) grade II in 2006, a secondary GB in 2008 and multiple extraneural metastases in 2011. Follow up MRI showed a progress of the known mass lesion with new contrast medium enhancement (see Figure 1). Emergency surgery on the cervical spine with laminectomy of cervical vertebra 5 and 6, pediculotomy of cervical vertebra 6 and subtotal tumor resection was performed (see Figures 3 and 4). The mass lesions in the lung and the cervical spine were histologically confirmed as metastases from the cerebral glioblastoma (see Figure 6). Because of the multiple mass lesions in different tissues staging was completed with MRI of the whole spine showing multifocal osseous metastases (see Figure 5).
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