Spinal and cervical nodal metastases in apatient with glioblastoma.

Abstract

This article presents the rare case of a54-year-old gentleman with primary glioblastoma developing multiple extracranial metastases 7months after diagnosis. Initially, the patient complained of progressive headaches, confusion, and weakness of the left arm. Magnetic resonance imaging of the brain showed aright temporoparietal tumor with substantial surrounding subcortical edema and midline shift to the left. Two consecutive craniotomies resulted in complete microsurgical resection of the lesion. Histology was consistent with aWorld Health Organization gradeIV, IDH-wildtype glioblastoma. Further treatment was standard chemoradiation including intensity-modulated radiotherapy with oral temozolomide chemotherapy. Seven months after diagnosis, the cranial lesion progressed, and the patient developed painful metastases in multiple bones and suspicious right-sided cervical lymph nodes. Immunohistochemistry and molecular signature supported the case of ametastatic glioblastoma. Further treatment was palliative radiotherapy of the spinal lesions along with symptomatic pain management. Extracranial metastasis of glioblastoma is arare complication of which only afew cases have been reported in the literature. Little is known about the precise mechanisms of tumor dissemination and the appropriate treatment.