Abstract
Glioblastoma, the most common and aggressive primary glial tumor, has a median survival time of approximately 3 months without medical treatment. Surgical resection, radiotherapy, and chemotherapy are the main methods of treatment and have been shown to increase life expectancy 1 to 2 years. The tumor has an infiltrative growth pattern that distorts the normal anatomy and can extend to distant parts of the brain along white matter tracts. While glioblastoma commonly infiltrates surrounding brain tissue and intracranial metastases to the meninges and spinal cord are frequently reported, extra-cranial metastases are extremely rare. This is most probably due to the lack of lymphatic vessels in the brain and inability of the malignant cells to invade blood vessels. We present a case of a 56- year-old female with a history of right temporal glioblastoma, who was found to have biopsy proven metastases to the lung. The patient presented for a chest x-ray, as part of a requirement for a clinical trial, and was found to have bilateral lung nodules; a subsequent chest computed tomography (CT) scan showed numerous pulmonary nodules and low density lesions in the liver. The patient underwent right thoracoscopic wedge resection. Frozen section and permanent sections were diagnostic of metastatic glioblastoma.
Highlights
Glioblastoma is the most aggressive primary brain neoplasm
While usually centered in the white matter of the cerebral hemispheres, infiltrating tumor cells frequently are present in an adjacent lobe or the opposite hemisphere as the tumor extends along the white matter tracts of the centrum semiovale, corpus callosum, and internal capsule [2,3]
Glioblastoma cells are immunopositive for glial fibrillary acid protein (GFAP)
Summary
Glioblastoma is the most aggressive primary brain neoplasm. Despite surgical resection, chemotherapy, and radiation, local recurrence occurs with high frequency [1]. A 56-year-old woman began to have increased migraine headaches They became constant and were localized to the right temporal, She underwent craniotomy and resection and her pathology showed the lesion to be a classical glioblastoma, large cell variant (Figure 1B),. Follow-up MRI four months later showed a right to left midline shift, an increase in size of the mass, and uncal herniation. She developed left sided hemiparesis and homonymous hemianopsia. A follow up CT scan demonstrated numerous pulmonary nodules and low density lesions were visualized in the liver (Figures 2A and 2B) She underwent a right lung wedge resection and a diagnosis of metastatic glioblastoma was confirmed.
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