Spinal cord and brain glioblastoma multiforme without previous craniotomy

Abstract

The frequency of symptomatic spinal cord metastases from brain glioblastoma multiforme (GBM) is between 1.3 and 8.8%. In almost all cases, there has been a history of surgical manipulation or radiation therapy that might have altered the blood‐brain barrier and introduced tumor cells through the cerebrospinal fluid pathways. The interval between the intracerebral GBM and its intramedullary metastasis is 12‐14 months and the mean survival time, under this condition, never exceeds 6 months.2‐4 However, in the absence of previous surgery or radiotherapy, it is difficult to distinguish between true metastasic from multicentric central nervous system GBM, as occurred in our case. 1‐4 A 52-year-old woman presented with a 2-month history of cervical pain and numbness in the left upper extremity; she was admitted with progressive paraparesis and acute urinary retention. Cervical magnetic resonance (MR) imaging demonstrated an intramedullary C4‐6 mass, which enhanced after Gd injection (Fig. 1). The tumor was resected after cervical laminectomy. Histopathological examination revealed that the lesion was a GBM. Considering this diagnosis, we performed brain MR imaging 1 week after the spinal cord surgery and discovered an enhancing mass, 2 cm in diameter, located in the right atrium (Fig. 2). Twenty days after the initial surgery, the intracerebral lesion was resected and its histopathological features were also consistent with a GBM.