Multifocal and Multicentric Glioblastoma with Leptomeningeal Gliomatosis: A Case Report and Review of the Literature

Sophia F Shakur,Ryan T Merrell,Esther Bit-Ivan,William G Watkin,Hamad I Farhat

doi:10.1155/2013/132679

Abstract

Glioblastoma (GBM) rarely presents as an infratentorial tumor in adults. The authors present a case of concomitant supratentorial and infratentorial GBM in an adult. A 72-year-old man presented with headache, nausea, vomiting, and lightheadedness. Initial MR images revealed enhancing masses in the right cerebellum and right posterior periventricular region. The patient underwent a suboccipital craniotomy and resection of the cerebellar lesion. Final histopathology was consistent with glioblastoma. The patient went on to receive standard radiation treatment for GBM with concurrent and adjuvant temozolomide. However, the patient experienced clinical deterioration within a few days after starting radiotherapy. He and his family decided to forego treatment and pursue palliative care. The patient expired three months after the initial diagnosis. Autopsy findings supported the diagnosis of GBM with leptomeningeal gliomatosis and involvement of the cerebrum, cerebellum, and spinal cord. The authors review the literature and propose that the pathogenesis of multiple and multicentric GBM may involve neural stem cells within the subventricular zone or could result from tumor dissemination along established CNS routes, such as white matter tracts and CSF pathways.

Highlights

Glioblastoma (GBM) is the most common intraparenchymal primary brain tumor, representing approximately 30% of all brain tumors and 50% of astrocytomas [1, 2]
Multifocal glioma consists of tumors separated by white matter tracts within the same hemisphere, whereas multicentric glioma consists of tumors in opposite hemispheres or separated by the tentorium
Autopsy findings supported the diagnosis of GBM with leptomeningeal gliomatosis and involvement of the cerebrum, cerebellum, spinal cord, neurohypophysis, and choroid plexus

Summary

Introduction

Glioblastoma (GBM) is the most common intraparenchymal primary brain tumor, representing approximately 30% of all brain tumors and 50% of astrocytomas [1, 2]. Multifocal glioma consists of tumors separated by white matter tracts within the same hemisphere, whereas multicentric glioma consists of tumors in opposite hemispheres or separated by the tentorium. Multicentric GBM involving the supratentorial and infratentorial regions is even more rare [8, 12]. We report a case of a multifocal and multicentric GBM involving the supratentorial and infratentorial regions in an adult and review the literature on all previously documented cases. We discuss the pathogenesis of this unique presentation of GBM, thereby providing greater insight into the origin and growth of GBM. This insight may lead to changes to the treatment approach of this rare presentation of GBM. Glial fibrillary acidic protein (GFAP) was strongly positive in the tumor cells (Figure 3)

Case Report

Findings

Discussion

Conclusions