Abstract
BackgroundGlioblastoma (GBM) is known for its devastating intracranial infiltration and its unfavorable prognosis, while extracranial involvement is a very rare event, more commonly attributed to IDH wild-type (primary) GBM evolution.Case presentationWe present a case of a young woman with a World Health Organization (WHO) grade II Astrocytoma evolved to WHO grade IV IDH mutant glioblastoma, with subsequent development of lymphatic and bone metastases, despite the favorable biomolecular pattern and the stability of the primary brain lesion.ConclusionsOur case highlights that grade II Astrocytoma may evolve to a GBM and rarely lead to a secondary metastatic diffusion, which can progress quite rapidly; any symptoms referable to a possible systemic involvement should be carefully investigated.
Highlights
Glioblastoma (GBM) is known for its devastating intracranial infiltration and its unfavorable prognosis, while extracranial involvement is a very rare event, more commonly attributed to Isocitrate dehydrogenase (IDH) wild-type GBM evolution.Case presentation: We present a case of a young woman with a World Health Organization (WHO) grade II Astrocytoma evolved to WHO grade IV IDH mutant glioblastoma, with subsequent development of lymphatic and bone metastases, despite the favorable biomolecular pattern and the stability of the primary brain lesion
IDH wild-type GBM develops de novo in elderly (60–80 years) patients representing approximately the 90% of all cases of GBM, while IDH mutant GBM is typical of younger people, has a more positive biomolecular pattern and is associated with a better prognosis [1]
Despite its highly invasive nature, GBM metastases are rare and this is putatively attributed to the short overall survival and the lack of a favorable environment for an extracranial spreading of tumor cells [2, 3]
Summary
Glioblastoma (GBM) is known for its devastating intracranial infiltration and its unfavorable prognosis, while extracranial involvement is a very rare event, more commonly attributed to IDH wild-type (primary) GBM evolution.Case presentation: We present a case of a young woman with a World Health Organization (WHO) grade II Astrocytoma evolved to WHO grade IV IDH mutant glioblastoma, with subsequent development of lymphatic and bone metastases, despite the favorable biomolecular pattern and the stability of the primary brain lesion. We report the case of a patient presented with a World Health Organization (WHO) grade II astrocytoma which evolved to an IDH mutant GBM (WHO IV) with subsequent extracranial metastatic diffusion. The lesion remained stable at the following six-months follow-up MRI studies until October 2017, when the patient underwent a new brain surgery for neuroradiological findings of locoregional recurrence (Fig. 1, B1–2), without any clinical worsening.
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