Peritoneal metastasis of glioblastoma multiforme via ventriculo-peritoneal shunt

Abstract

Internal drainage of cerebrospinal fluid to the abdominal cavity via a ventriculoperitoneal shunt is commonly used for treatment of obstructive hydrocephalus. High-grade gliomas often block the natural cerebrospinal fluid pathways, but a ventriculoperitoneal shunt, as an artificial anastomosis, can provide a pathway for tumor cells to be spread with the cerebrospinal fluid. We present a 27-year-old-male diagnosed with intracranial glioblastoma multiforme. The patient had abdominal distension, poor appetite, and vomiting. Abdominal computed topography showed a large amount of ascites in the abdominal cavity and multiple tiny soft tissue nodules of the omentum. Endoscopic biopsy of nodules over the omentum was performed by a general surgeon. Pathologic examination revealed metastatic glioblastoma multiforme. Unfortunately, the patient died 2 months after peritoneal metastasis of glioblastoma multiforme via a ventriculoperitoneal shunt was impressed. The pattern of peritoneal metastasis seen in this patient is typical of tumors that directly seed the peritoneal cavity and implicates the ventriculoperitoneal shunt as the vehicle of extraneural spread. Although metastasis via a ventriculoperitoneal shunt is rare, the possibility should be considered if patients with glioblastoma multiforme complain of unexplained abdominal distension, increase in abdominal girth, or persistent abdominal pain.