RARE-16MULTIFOCAL GLIOBLASTOMA: A PEDIATRIC CASE AND LITERATURE REVIEW

Abstract

INTRODUCTION: Multifocal glioblastoma is a rare entity in adults and children with an extremely poor prognosis. Multifocal GBM is thought to arise from the spread of the tumor via a connecting pathway. Because of this spread, complete resection is generally unfeasible, especially if it involves deep brain structures. Few cases have been reported in pediatric patients; here we present a pediatric case and literature review. CASE PRESENTATION: Our patient is a 14 year old Caucasian girl who presented following several weeks of headache, vertigo, nausea, and visual blurriness. An MRI of her head revealed a large expansile mass centered in the right thalamus with areas of central necrosis causing mass effect and involvement of the right basal ganglia, medial right temporal lobe, and hippocampus with additional foci identified in the left corpus callosum, hypothalamus, and lateral cerebellum. MRI of the spine showed no additional sites of disease. She was admitted and underwent an endoscopic third ventriculostomy, biopsy of the left periventricular tumor, fenestration of the septum pellucidum, and placement of an external ventricular drain. Pathology showed a WHO grade 3 anaplastic astrocytoma. Two treatment options were considered: primary chemoradiotherapy or surgery with adjuvant chemoradiotherapy. The survival benefit of the surgical approach in multifocal disease is unclear; however, primary radiotherapy has the risk of swelling leading to decreased quality of life. Because of concerns of edema with primary radiotherapy, and in light of the fact that she was already experiencing progressive symptoms due to mass effect, she underwent subtotal resection. Pathology at that time showed small amounts of necrosis making her lesion a grade IV tumor. She then proceeded to adjuvant chemoradiotherapy. CONCLUSION: Multifocal glioblastoma is a rarely encountered brain tumor in children with inadequate treatment options. We present a case and literature review of this entity.