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Huang WZ, Chen HC, Chang TK, You WC, Jan YJ, Chou YC. Extracranial metastasis of pediatric glioblastoma: case report and literature review. Childs Nerv Syst 2024; 40:933-937. [PMID: 37982875 DOI: 10.1007/s00381-023-06229-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
Glioblastoma (GBM) is a rare primary brain tumor in children, and extracranial metastases of pediatric GBM are particularly uncommon. We present the case of a 10-year-old girl with pediatric GBM who developed multiple extracranial metastases, including cervical lymph nodes, spine, and lung. We discuss the rarity of extracranial metastases in GBM and explore possible mechanisms of dissemination. The patient underwent surgical resections, radiotherapy, and chemotherapy, but the metastatic disease progressed despite treatment. We emphasize the need to consider extracranial metastases in pediatric GBM patients and adopt multimodal treatment approaches for managing this rare clinical entity. As the survival rates of pediatric GBM patients are improving, awareness of extracranial metastases is crucial for optimizing treatment outcomes.
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Affiliation(s)
- Wei-Zhi Huang
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Te-Kau Chang
- Section of Pediatric Hematology, China Medical University Children's Hospital, Taichung, Taiwan
| | - Weir Chiang You
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yee-Jee Jan
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Cheng Chou
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, No.1650, Sec. 4, Taiwan Blvd., Taichung, 407, Taiwan.
- Department of Applied Chemistry, National Chi Nan University, Nantou, Taiwan.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Spinal Metastasis in a Patient with Supratentorial Glioblastoma with Primitive Neuronal Component: A Case Report with Clinical and Molecular Evaluation. Diagnostics (Basel) 2023; 13:diagnostics13020181. [PMID: 36672991 PMCID: PMC9858260 DOI: 10.3390/diagnostics13020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Glioblastoma (GBM) is regarded as an aggressive brain tumor that rarely develops extracranial metastases. Despite well-investigated molecular alterations in GBM, there is a limited understanding of these associated with the metastatic potential. We herein present a case report of a 43-year-old woman with frontal GBM with primitive neuronal component who underwent gross total resection followed by chemoradiation. Five months after surgery, the patient was diagnosed with an intraspinal GBM metastasis. Next-generation sequencing analysis of both the primary and metastatic GBM tissues was performed using the Illumina TruSight Tumor 170 assay. The number of single nucleotide variants observed in the metastatic sample was more than two times higher. Mutations in TP53, PTEN, and RB1 found in the primary and metastatic tissue samples indicated the mesenchymal molecular GBM subtype. Among others, there were two inactivating mutations (Arg1026Ile, Trp1831Ter) detected in the NF1 gene, two novel NOTCH3 variants of unknown significance predicted to be damaging (Pro1505Thr, Cys1099Tyr), one novel ARID1A variant of unknown significance (Arg1046Ser), and one gene fusion of unknown significance, EIF2B5-KIF5B, in the metastatic sample. Based on the literature evidence, the alterations of NF1, NOTCH3, and ARID1A could explain, at least in part, the acquired invasiveness and metastatic potential in this particular GBM case.
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Baskurt O, Kurtulus Y, Yavuz AY, Avci İ. Extracranial metastasis of recurrent glioblastoma to the parotid gland: a case report and review of the literature. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Glioblastomas are the most common and highly malignant primary brain tumors in adults with a median survival of 15 months even with appropriate treatment. Extracranial metastases are extremely rare due to the poor prognosis not allowing sufficient time to spread. We report an extremely rare case of extracranial metastasis of supra-tentorial glioblastoma involving the skin, subcutaneous and muscular layers, periauricular region and parotid gland, and review the literature. A total of 13 glioblastoma parotid gland metastases cases have been hitherto described.
Main body of the abstract
A 42-year-old man underwent surgery for right temporal glioblastoma and received 60 Gy/30 fractions radiotherapy together with temozolomide at 75 mg/m2. Seven months later, the tumor relapsed and the patient underwent a second surgery while chemotherapy continued. Fifteen months later, he complained of swelling in the right neck region. Fine needle aspiration and tru-cut biopsy revealed a high-grade malignant tumor infiltration within the parotid gland. Despite salvage chemotherapy and adjuvant radiotherapy, in his follow-up after 6 months neck swelling increased. The patient declined any treatment modality and continues his life 39 months after the primary diagnosis of intracranial glioblastoma.
Short conclusion
Due to the recurrence rate of intracranial glioblastoma and its malignant nature; close imaging follow-up is highly crucial. The increase in reported cases of its extracranial metastases is generally due to the modern diagnostic tools and prolonged survival attributed to the improvement in treatment modalities where now radical surgery with adjuvant radiotherapy and chemotherapy is standard protocol. Patients with glioblastomas presenting with swelling in the cervical region should be investigated to rule out parotid gland metastasis.
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Leptomeningeal disease in glioblastoma: endgame or opportunity? J Neurooncol 2021; 155:107-115. [PMID: 34623599 DOI: 10.1007/s11060-021-03864-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Glioblastoma is an aggressive cancer with a notoriously poor prognosis. Recent advances in treatment have increased overall survival, though this may be accompanied by an increased incidence of leptomeningeal disease (LMD). LMD carries a particularly severe prognosis and remains a late stage manifestation of glioblastoma without satisfactory treatment. The objective of this review is to survey the literature on treatment of LMD in glioblastoma and to more fully characterize the current therapeutic strategies. METHODS The authors performed a systematic review following PRISMA criteria on PubMed and OVID databases. Articles that included adult patients with LMD from glioblastoma were retrieved and reviewed. RESULTS LMD in glioblastoma patients is increasing in incidence, with reports of up to 21%. The overall survival without treatment is alarmingly brief, with patients surviving between 1.6-3.8 months. All studies showed that treatment does improve overall survival significantly, increasing to 11.7 months in one study. However, no one adjuvant or surgical therapy has been shown to improve survival in LMD significantly over another. Direct treatment methods include chemotherapy (standard, anti-angiogenic, intrathecal, immunotherapy), and radiation. Hydrocephalus is a complication in LMD that can be treated with ventriculoperitoneal shunt placement, however treating hydrocephalus and delivering intrathecal chemotherapy is a challenge. CONCLUSION Though evidence remains lacking and there is no consensus, treatments show a trend towards improving survival and should be considered on a case-by-case basis. Further studies are necessary in the pursuit of a standard of care.
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Schwock J, Mirham L, Ghorab Z. Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update. Acta Cytol 2021; 65:529-540. [PMID: 34311461 PMCID: PMC8686714 DOI: 10.1159/000517480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/27/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Extraneural/-cranial metastases (ENM) of primary central nervous system (CNS) tumors are rare and may be diagnostically challenging. We describe the cytomorphological and pertinent clinical features of ENM in a case series assessed by fine-needle aspiration (FNA). A search of the laboratory information systems of 2 tertiary care centers in Toronto (2000-2015) was performed. Cases with direct extracranial/-spinal extension of CNS neoplasms were excluded. Microscopic slides of FNA and surgical specimens were reviewed. Demographic and clinicopathological data were retrieved. CASE PRESENTATION Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22-56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area. DISCUSSION/CONCLUSION ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.
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Affiliation(s)
- Joerg Schwock
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lorna Mirham
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Wu X, Wang J, Wang Y. Multiple intracranial and extracranial metastases from postoperative glioblastoma: A case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nakata S, Yuan M, Rubens JA, Kahlert UD, Maciaczyk J, Raabe EH, Eberhart CG. BCOR Internal Tandem Duplication Expression in Neural Stem Cells Promotes Growth, Invasion, and Expression of PRC2 Targets. Int J Mol Sci 2021; 22:ijms22083913. [PMID: 33920124 PMCID: PMC8070097 DOI: 10.3390/ijms22083913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous system tumor with BCL6-corepressor internal tandem duplication (CNS-BCOR ITD) is a malignant entity characterized by recurrent alterations in exon 15 encoding the essential binding domain for the polycomb repressive complex (PRC). In contrast to deletion or truncating mutations seen in other tumors, BCOR expression is upregulated in CNS-BCOR ITD, and a distinct oncogenic mechanism has been suggested. However, the effects of this change on the biology of neuroepithelial cells is poorly understood. In this study, we introduced either wildtype BCOR or BCOR-ITD into human and murine neural stem cells and analyzed them with quantitative RT-PCR and RNA-sequencing, as well as growth, clonogenicity, and invasion assays. In human cells, BCOR-ITD promoted derepression of PRC2-target genes compared to wildtype BCOR. A similar effect was found in clinical specimens from previous studies. However, no growth advantage was seen in the human neural stem cells expressing BCOR-ITD, and long-term models could not be established. In the murine cells, both wildtype BCOR and BCOR-ITD overexpression affected cellular differentiation and histone methylation, but only BCOR-ITD increased cellular growth, invasion, and migration. BCOR-ITD overexpression drives transcriptional changes, possibly due to altered PRC function, and contributes to the oncogenic transformation of neural precursors.
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Affiliation(s)
- Satoshi Nakata
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.N.); (M.Y.)
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.A.R.); (E.H.R.)
| | - Ming Yuan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.N.); (M.Y.)
| | - Jeffrey A. Rubens
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.A.R.); (E.H.R.)
| | - Ulf D. Kahlert
- Neurosurgical Clinic, Medical Faculty, Heinrich-Heine University Duesseldorf, D-40225 Dusseldorf, Germany;
| | - Jarek Maciaczyk
- Department of Neurosurgery, University of Bonn, D-53127 Bonn, Germany;
| | - Eric H. Raabe
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (J.A.R.); (E.H.R.)
| | - Charles G. Eberhart
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; (S.N.); (M.Y.)
- Correspondence:
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Birzu C, Tran S, Bielle F, Touat M, Mokhtari K, Younan N, Psimaras D, Hoang‐Xuan K, Sanson M, Delattre J, Idbaih A. Leptomeningeal Spread in Glioblastoma: Diagnostic and Therapeutic Challenges. Oncologist 2020; 25:e1763-e1776. [PMID: 33394574 PMCID: PMC7648332 DOI: 10.1634/theoncologist.2020-0258] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor. Leptomeningeal spread (LMS) is a severe complication of GBM, raising diagnostic and therapeutic challenges in clinical routine. METHODS We performed a review of the literature focused on LMS in GBM. MEDLINE and EMBASE databases were queried from 1989 to 2019 for articles describing diagnosis and therapeutic options in GBM LMS, as well as risk factors and pathogenic mechanisms. RESULTS We retrieved 155 articles, including retrospective series, case reports, and early phase clinical trials, as well as preclinical studies. These articles confirmed that LMS in GBM remains (a) a diagnostic challenge with cytological proof of LMS obtained in only 35% of cases and (b) a therapeutic challenge with a median overall survival below 2 months with best supportive care alone. For patients faced with suggestive clinical symptoms, whole neuroaxis magnetic resonance imaging and cerebrospinal fluid analysis are both recommended. Liquid biopsies are under investigation and may help prompt a reliable diagnosis. Based on the literature, a multimodal and personalized therapeutic approach of LMS, including surgery, radiotherapy, systemic cytotoxic chemotherapy, and intrathecal chemotherapies, may provide benefits to selected patients. Interestingly, molecular targeted therapies appear promising in case of actionable molecular target and should be considered. CONCLUSION As the prognosis of glioblastoma is improving over time, LMS becomes a more common complication. Our review highlights the need for translational studies and clinical trials dedicated to this challenging condition in order to improve diagnostic and therapeutic strategies. IMPLICATIONS FOR PRACTICE This review summarizes the diagnostic tools and applied treatments for leptomeningeal spread, a complication of glioblastoma, as well as their outcomes. The importance of exhaustive molecular testing for molecular targeted therapies is discussed. New diagnostic and therapeutic strategies are outlined, and the need for translational studies and clinical trials dedicated to this challenging condition is highlighted.
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Affiliation(s)
- Cristina Birzu
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
| | - Suzanne Tran
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neuropathologie‐EscourolleParisFrance
| | - Franck Bielle
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neuropathologie‐EscourolleParisFrance
| | - Mehdi Touat
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
| | - Karima Mokhtari
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neuropathologie‐EscourolleParisFrance
| | - Nadia Younan
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
| | - Dimitri Psimaras
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
| | - Khe Hoang‐Xuan
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
| | - Marc Sanson
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
| | - Jean‐Yves Delattre
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
| | - Ahmed Idbaih
- Sorbonne Université, INSERM, Centre National de la Recherche Scientifique (CNRS), Unité Mixte de Recherche (UMR) S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Assistance Publique–Hôpitaux de Paris (AP‐HP), Hôpitaux Universitaires La Pitié Salpêtrière—Charles Foix Service de Neurologie 2‐MazarinParisFrance
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Extracranial Metastases From Glioblastoma With Primitive Neuronal Components on FDG PET/CT. Clin Nucl Med 2020; 45:e162-e164. [PMID: 31876829 DOI: 10.1097/rlu.0000000000002896] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 17-year-old girl with World Health Organization grade IV glioblastoma with primitive neuronal components (histone H3 G34-mutant and IDH1 wild type) underwent whole-body FDG PET/CT staging due to vertebral metastases on initial MRI. PET/CT revealed extracranial metastatic disease with spinal leptomeningeal dissemination, osseous metastases, and peritoneal seeding via a ventriculoperitoneal shunt. Glioblastoma is uncommon in pediatric patients and particularly those with primitive neuronal components. Extracranial metastases from glioblastoma are more common in those with primitive neuronal components. This case demonstrates the utility of FDG PET/CT for revealing distant metastases from glioblastoma.
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Tan D, Lai LT, Daly CD, Tran V, Maingard J, Timms C. Spinal Pleomorphic Xanthoastrocytoma: Case Report and Literature Review. World Neurosurg 2020; 141:25-32. [PMID: 32442731 DOI: 10.1016/j.wneu.2020.05.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Pleomorphic xanthoastrocytoma (PXA) is an uncommon central nervous system neoplasm with an overall favorable survival prognosis. Metastatic spread of PXA to the spinal cord and the cauda equina is rare and may have a different clinicopathologic course. Treatment and prognostic outcomes, in this context, are not well defined. We discuss a case of a 30-year-old patient with known cerebral PXA presenting with metastatic spinal anaplastic PXA and present a literature analysis of treatment outcomes.
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Affiliation(s)
- Darius Tan
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia.
| | | | - Vu Tran
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | - Julian Maingard
- Department of Radiology, Monash Health, Melbourne, Australia; Department of Medicine, Faculty of Health, Deakin University, Waurn Ponds, Australia
| | - Craig Timms
- Department of Neurosurgery, Monash Health, Melbourne, Australia
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Unique Case Report of a Meningeal Sarcoma Arising during Ongoing Treatment for Progressing Intraparenchymal Glioma. Case Rep Oncol Med 2019; 2019:7950782. [PMID: 31885975 PMCID: PMC6900946 DOI: 10.1155/2019/7950782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022] Open
Abstract
Radiation-induced sarcomas in the brain are extremely rare, usually occur with an average latency of 9 years, and are associated with poor outcomes. Latency periods shorter than 1 year may indicate a genetic predisposition such as Li-Fraumeni syndrome. A 34-year-old man underwent initial tumor resection and radiation therapy for a World Health Organization (WHO) Grade II Astrocytoma. Within 6 months, the tumor recurred as WHO Grade III and was treated with temozolomide and then bevacizumab. Despite the patient's apparent improving condition, MRI revealed new dural-based lesions 10 months after radiation therapy and identified as high-grade sarcoma. The patient resumed bevacizumab, began NovoTTF treatment for progressing glioma, and ifosfamide/doxorubicin for the sarcoma. Genetic testing revealed no pathogenic mutation in the TP53 gene. Ultimately, treatment was unsuccessful and the patient succumbed to glioma and sarcoma within 2 years of initial diagnosis. This case was unique due to the rapidly progressing glioma and sudden appearance of a high-grade sarcoma. It is unusual to have two separate intracranial primary cancers with each requiring a different chemotherapy regimen. We discuss the difficulty of simultaneously treating with separate chemotherapy regimens. It remains unclear whether the sarcoma was induced by the radiation treatment or a genetic predisposition.
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Kam KL, Snuderl M, Khan O, Wolinsky JP, Gondi V, Grimm S, Horbinski C. Using methylation profiling to diagnose systemic metastases of pleomorphic xanthoastrocytoma. Neurooncol Adv 2019; 2:vdz057. [PMID: 32002518 PMCID: PMC6978194 DOI: 10.1093/noajnl/vdz057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
- Kwok-Ling Kam
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York University, New York
| | - Osaama Khan
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jean-Paul Wolinsky
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Vinai Gondi
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sean Grimm
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Craig Horbinski
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Magdaleno-Tapial J, Valenzuela-Oñate C, Pérez-Pastor G, Alegre de Miquel V. Skin Metastasis of Glioblastoma Multiforme: A Case Report and Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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14
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Magdaleno-Tapial J, Valenzuela-Oñate C, Pérez-Pastor G, Alegre de Miquel V. Metástasis cutánea de glioblastoma multiforme: presentación de un caso y revisión de la literatura. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:780-783. [DOI: 10.1016/j.ad.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/15/2018] [Accepted: 05/23/2018] [Indexed: 10/27/2022] Open
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Wright CH, Wright J, Onyewadume L, Raghavan A, Lapite I, Casco-Zuleta A, Lagman C, Sajatovic M, Hodges TR. Diagnosis, treatment, and survival in spinal dissemination of primary intracranial glioblastoma: systematic literature review. J Neurosurg Spine 2019; 31:723-732. [PMID: 31374545 DOI: 10.3171/2019.5.spine19164] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/15/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal metastases from primary intracranial glioblastoma (GBM) are infrequently reported, and the disease has yet to be well characterized. A more accurate description of its clinical presentation and patient survival may improve understanding of this pathology, guide patient care, and advocate for increased inclusion in GBM research. The authors sought to describe the clinical presentation, treatment patterns, and survival in patients with drop metastases secondary to primary intracranial GBM. METHODS A systematic review was performed using the PRISMA guidelines. PubMed/MEDLINE, Scopus, Web of Science, and Cochrane databases were queried for abstracts that included patients with primary intracranial GBM and metastases to the spinal axis. Descriptive statistics were used to evaluate characteristics of the primary brain lesion, timing of spinal metastases, clinical symptoms, anatomical location of the metastases, and survival and treatment parameters. Kaplan-Meier analysis and log-rank analysis of the survival curves were performed for selected subgroups. RESULTS Of 1225 abstracts that resulted from the search, 51 articles were selected, yielding 86 subjects. The patients' mean age was 46.78 years and 59.74% were male. The most common symptom was lumbago or cervicalgia (90.24%), and this was followed by paraparesis (86.00%). The actuarial median survival after the detection of spinal metastases was 2.8 months and the mean survival was 2.72 months (95% CI 2.59-4.85), with a 1-year cumulative survival probability of 2.7% (95% CI 0.51%-8.33%). A diagnosis of leptomeningeal disease, present in 53.54% of the patients, was correlated, and significantly worse survival was on log-rank analysis in patients with leptomeningeal disease (p = 0.0046; median survival 2.5 months [95% CI 2-3] vs 4.0 months [95% CI 2-6]). CONCLUSIONS This study established baseline characteristics of GBMs metastatic to the spinal axis. The prognosis is poor, though these results will provide patients and clinicians with more accurate survival estimates. The quality of studies reporting on this disease pathology is still limited. There is significant need for improved reporting methods for spinal metastases, either through enrollment of these patients in clinical trials or through increased granularity of coding for metastatic central nervous system diseases in cancer databases.
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Affiliation(s)
- Christina Huang Wright
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Case Western Reserve University School of Medicine; and
| | - James Wright
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Case Western Reserve University School of Medicine; and
| | | | | | - Isaac Lapite
- 2Case Western Reserve University School of Medicine; and
| | | | - Carlito Lagman
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Case Western Reserve University School of Medicine; and
| | - Martha Sajatovic
- 3Neurological and Behavioral Outcomes Research Center and
- 4Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Tiffany R Hodges
- 1Department of Neurological Surgery, University Hospitals Cleveland Medical Center
- 2Case Western Reserve University School of Medicine; and
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16
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Wu L, Ou Y, Liu B, Liu W. Scalp Metastasis of Anaplastic Oligodendroglioma. World Neurosurg 2019; 128:448-451. [PMID: 31125773 DOI: 10.1016/j.wneu.2019.05.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 05/12/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Scalp metastases from anaplastic oligodendroglioma (AO) are extremely rare and mostly involve intracranial recurrence or widely metastatic disease. Here we describe an exceptional case of histopathologically proven scalp metastasis of AO 6 years after surgical resection and postoperative adjuvant radiation. CASE DESCRIPTION A 42-year-old woman presented with several months of progressive headache and dizziness. Preoperative magnetic resonance imaging (MRI) showed an irregular enhancing lesion in the left frontal lobe extending to the ependymal surface. Left frontal craniotomy was performed through a coronal approach, and gross total resection was achieved. Pathologic examination confirmed a World Health Organization grade III AO. The patient subsequently received 60 Gy of external beam radiotherapy in 30 fractions over 6 weeks. During 8 years of follow-up, the patient remained symptom free, and no evidence of intracranial recurrence was found. However, 6 years after intracranial tumor resection, the patient noticed a subcutaneous mass in her right frontal scalp, which was the site contralateral to her craniotomy. MRI revealed a homogeneously marked enhancing nodular lesion in the subcutaneous tissue of the right frontal scalp without intracranial recurrence. Gross total resection was performed, and the pathologic findings, which identified the mass as an AO, were consistent with those of the primary left frontal tumor. CONCLUSIONS This study presents a rare case of long-term AO scalp metastasis without intracranial recurrence. Intraoperative seeding and longer survival for oligodendroglial tumors may cause this rare entity. Optimal surgical strategies and standard operative procedures can promote the prevention of iatrogenic seeding.
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Affiliation(s)
- Liang Wu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunwei Ou
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baiyun Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Weiming Liu
- Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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17
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Romo CG, Palsgrove DN, Sivakumar A, Elledge CR, Kleinberg LR, Chaichana KL, Gocke CD, Rodriguez FJ, Holdhoff M. Widely metastatic IDH1-mutant glioblastoma with oligodendroglial features and atypical molecular findings: a case report and review of current challenges in molecular diagnostics. Diagn Pathol 2019; 14:16. [PMID: 30738431 PMCID: PMC6368694 DOI: 10.1186/s13000-019-0793-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 02/01/2019] [Indexed: 01/06/2023] Open
Abstract
Background Gliomas with 1p/19q-codeletion as well as mutation of isocitrate dehydrogenase (IDH) 1 are typically characterized as oligodendrogliomas with comparatively good response to treatment with radiation and chemotherapy. Case presentation We present the case of a 28-year-old man with an IDH1 and TP53 mutant high grade glioma with abnormalities in chromosomes 1 and 19 suggestive of anaplastic oligodendroglioma that rapidly progressed to widespread metastatic disease. Biopsy of a liver lesion confirmed metastasis of the patient’s known brain primary and chemotherapy with temozolomide was initiated. The patient’s rapidly growing tumor burden with fulminant liver failure and tumor lysis led to multisystem failure of which the patient died. Further molecular testing illustrated features more consistent with glioblastoma: multiple large chromosomal aberrations including loss of whole chromosome 1 and 2q; gain/amplification of MYCN, MET, and CDK4; loss of CDKN2A/B; and an ATRX mutation. Conclusion This case illustrates the importance of higher level molecular diagnostic testing for patients with particularly aggressive disease progression that is not concordant with standard prognoses. Additional data on cases with atypical alterations of 1p and 19q are needed to better understand the distinct biology of these cancers so that appropriate therapies can be developed. Electronic supplementary material The online version of this article (10.1186/s13000-019-0793-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carlos G Romo
- Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1550 Orleans Street, 1M16, Baltimore, MD, 21287, USA
| | - Doreen N Palsgrove
- Department of Pathology, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Ananyaa Sivakumar
- Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1550 Orleans Street, 1M16, Baltimore, MD, 21287, USA
| | - Christen R Elledge
- Department of Radiation Oncology, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Lawrence R Kleinberg
- Department of Radiation Oncology, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Kaisorn L Chaichana
- Department of Neurosurgery, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Christopher D Gocke
- Department of Pathology, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University of Medicine, Baltimore, MD, USA
| | - Matthias Holdhoff
- Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1550 Orleans Street, 1M16, Baltimore, MD, 21287, USA.
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18
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Saraf AJ, Elhawary G, Finlay JL, Scott S, Olshefski R, Halverson M, Boue DR, AbdelBaki MS. Complete Remission of an Extracranially Disseminated Anaplastic Pleomorphic Xanthoastrocytoma With Everolimus: A Case Report and Literature Review. Pediatr Neurol 2018; 88:65-70. [PMID: 30322731 DOI: 10.1016/j.pediatrneurol.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/19/2018] [Accepted: 09/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical resection is the treatment of choice for pleomorphic xanthoastrocytoma, while chemotherapy and radiation therapy are typically used in patients with anaplasia, metastasis, or sometimes in subtotally resected cases, especially upon recurrence. Extracranial dissemination has been only rarely reported. We describe a five year old boy with the rare occurrence multiply recurrent and extracranially disseminated anaplastic pleomorphic xanthoastrocytoma. A complete resolution of his tumor was achieved for greater than two years thus far after administering everolimus. METHODS We performed a comprehensive literature review of all pleomorphic xanthoastrocytoma cases; 359 cases were described, and 132 of these individuals were less than 18 years of age. RESULTS Gross total resection was achieved in only 132 (36.7%) cases, while additional therapy was administered in 186 patients. Only four patients in additon to our own have been documented with extracranial dissemination (four of five in the pediatric population); two patients who succumbed to their disease underwent subtotal resection of the primary tumor. CONCLUSIONS We report the first patient with extracranially disseminated anaplastic pleomorphic xanthoastrocytoma to be successfully maintained on everolimus as a single oral chemotherapy agent with complete resolution of the tumor. Pleomorphic xanthoastrocytoma can rarely disseminate extracranially in the pediatric population, hence pathologists and neuro-oncologists should be aware of this possibility.
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Affiliation(s)
- Amanda J Saraf
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Jonathan L Finlay
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Suzanne Scott
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Randal Olshefski
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio
| | - Mark Halverson
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Daniel R Boue
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Mohamed S AbdelBaki
- Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, Ohio.
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19
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Schwartz C, Romagna A, Machegger L, Weiss L, Huemer F, Fastner G, Kleindienst W, Weis S, Greil R, Winkler PA. Extensive Leptomeningeal Intracranial and Spinal Metastases in a Patient with a Supratentorial Glioblastoma Multiforme, IDH-Wildtype. World Neurosurg 2018; 120:442-447. [PMID: 30253992 DOI: 10.1016/j.wneu.2018.09.082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is usually characterized by diffuse, infiltrative growth and local tumor progression. Extensive leptomeningeal metastases are rarely observed. It is unclear which GBMs are prone to this specific growth pattern and progression, and standardized salvage treatment protocols are unavailable. CASE DESCRIPTION In a 45-year-old man without focal neurologic deficit, a right temporal GBM, IDH-wildtype (biomarkers MGMT promoter methylation negative, Ki-67 proliferation rate 70%) was diagnosed. Gross tumor resection followed by concomitant and adjuvant radiotherapy and chemotherapy with temozolomide was performed. Routine follow-up imaging 8 months later showed a right parietal meningeal tumor. Resection confirmed a distant GBM, and next-generation sequencing revealed high tumor mutational burden, high-frequency microsatellite instability, and a pharmacologically targetable KIT mutation. Complete neuraxis imaging revealed multiple contrast-enhancing tumors in the craniocervical junction and levels C7, Th8-Th11, and S1. The craniocervical tumors and the cervical spine from C1-C2 were irradiated as palliative care, and second-line combined chemotherapy and antiangiogenic therapy with irinotecan and bevacizumab was initiated, which was later changed to an immune-checkpoint blockade with pembrolizumab in combination with bevacizumab owing to tumor progression. Tumor growth was slowed, but the patient eventually developed a progressive paraparesis. Subsequent KIT-targeting tyrosine kinase inhibitor therapy with imatinib was administered for a short time. The patient died 13.8 months after initial diagnosis. CONCLUSIONS High-risk genetic profiles for GBMs prone to develop extensive leptomeningeal metastases need to be identified. Guidelines on preemptive, complete neuraxis imaging in certain patients with GBM as well as treatment guidelines need to be developed.
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Affiliation(s)
- Christoph Schwartz
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
| | - Alexander Romagna
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Machegger
- Division of Neuroradiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lukas Weiss
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria
| | - Florian Huemer
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria
| | - Gerd Fastner
- Department of Radiotherapy and Radio-Oncology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Waltraud Kleindienst
- Department of Neurology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Serge Weis
- Division of Neuropathology, Institute of Pathology and Microbiology, Neuromed Campus, Kepler University Hospital, Linz, Austria
| | - Richard Greil
- Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria; Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research, Paracelsus Medical University, Salzburg, Austria; Cancer Cluster Salzburg, Salzburg, Austria
| | - Peter A Winkler
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
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20
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Glioblastoma multiforme metastases to the masticator muscles and the scalp. J Clin Neurosci 2018; 53:237-239. [PMID: 29685418 DOI: 10.1016/j.jocn.2018.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/09/2018] [Indexed: 11/23/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor. Metastases outside the nervous system are a rare phenomenon. We present a pictographically striking case of GBM with metastases in the masticatory muscles of the infratemporal fossa and the scalp, in the context of a dense intracranial dissemination. Extracranial metastases of GBM have been reported anecdotally, while, to our knowledge, masticatory muscle metastases have been previously reported in only one case.
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21
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Takanen S, Bangrazi C, Caiazzo R, Raffetto N, Tombolini V. Multiple Bone Metastases from Glioblastoma Multiforme without Local Brain Relapse: A Case Report and Review of the Literature. TUMORI JOURNAL 2018; 99:e237-40. [DOI: 10.1177/030089161309900521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extracranial metastases from glioblastoma multiforme (GBM) are a very rare event, even if an increasing incidence has been documented. We report the case of a young woman with primary GBM who developed bone metastases without local brain relapse. Because of persistent headache and visual disturbances, in March 2011 the patient underwent magnetic resonance imaging (MRI) evidencing a temporoparietal mass, which was surgically resected. Histology revealed GBM. She was given concomitant chemoradiotherapy according to the Stupp regimen. After a 4-week break, the patient received 6 cycles of adjuvant temozolomide according to the standard 5-day schedule every 28 days. In December 2011 she complained of progressive low back pain, and MRI showed multiple bone metastases from primary GBM, confirmed by histology. Cases of metastatic GBM in concurrence with a primary brain tumor or local relapse are more common in the literature; only a few cases have been reported where extracranial metastases from GBM occurred without any relapse in the brain. Here we report our experience.
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Affiliation(s)
- Silvia Takanen
- Department of Radiation Oncology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Caterina Bangrazi
- Department of Radiation Oncology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Rossella Caiazzo
- Department of Radiation Oncology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Nicola Raffetto
- Department of Radiation Oncology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiation Oncology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
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22
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Sun Q, Xu R, Xu H, Wang G, Shen X, Jiang H. Extracranial metastases of high-grade glioma: the clinical characteristics and mechanism. World J Surg Oncol 2017; 15:181. [PMID: 28985756 PMCID: PMC5639596 DOI: 10.1186/s12957-017-1249-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background This presentation of two cases and literature review discusses the epidemiology, clinical manifestations, pathogenesis, diagnosis, treatment, and prognosis of high-grade glioma with extracranial metastases. Methods A retrospective analysis of the clinical features of two cases of malignant glioma, including metastatic sites, pathological data, and treatment methods, and a literature review was performed. Results Two patients developed extracranial metastases within 1 year after surgery for primary glioma. One patient developed cervical lymph node and bone metastases while the other developed bone metastases, and both patients died within 2 months after the diagnosis of the extracranial metastasis. Conclusion Extracranial metastases may develop from malignant gliomas. According to the literature, the most common extracranial site is intraspinal (along the neural axis), followed by the vertebrae, lungs, liver, and lymph nodes. The complex metastatic mechanism remains unclear, and the prognosis is very poor, with a survival duration of less than 6 months.
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Affiliation(s)
- Qian Sun
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Rui Xu
- Department of Surgical Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Hongbo Xu
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Gengming Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Xueming Shen
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Hao Jiang
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
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23
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Roelz R, Reinacher P, Jabbarli R, Kraeutle R, Hippchen B, Egger K, Weyerbrock A, Machein M. Surgical Ventricular Entry is a Key Risk Factor for Leptomeningeal Metastasis of High Grade Gliomas. Sci Rep 2015; 5:17758. [PMID: 26635136 PMCID: PMC4669436 DOI: 10.1038/srep17758] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/03/2015] [Indexed: 01/29/2023] Open
Abstract
Leptomeningeal metastasis (LM) of high grade gliomas (HGG) can lead to devastating disease courses. Understanding of risk factors for LM is important to identify patients at risk. We reviewed patient records and magnetic resonance imaging (MRI) of all patients with a first diagnosis of HGG who underwent surgery in our institution between 2008 and 2012. To assess the influence of potential risk factors for LM and the impact of LM on survival multivariate statistics were performed. 239 patients with a diagnosis of HGG and at least 6 months of MRI and clinical follow-up were included. LM occurred in 27 (11%) patients and was symptomatic in 17 (65%). A strong correlation of surgical entry to the ventricle and LM was found (HR: 8.1). Ventricular entry was documented in 137 patients (57%) and LM ensued in 25 (18%) of these. Only two (2%) of 102 patients without ventricular entry developed LM. Median overall survival of patients after diagnosis of LM (239 days) was significantly shorter compared to patients without LM (626 days). LM is a frequent complication in the course of disease of HGG and is associated with poor survival. Surgical entry to the ventricle is a key risk factor for LM.
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Affiliation(s)
- Roland Roelz
- Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.,Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg
| | - Peter Reinacher
- Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany.,Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, 45147, Germany
| | - Rainer Kraeutle
- Department of Nursing-IT, University Medical Center Freiburg, Hugstetter Str. 55, 79106 Freiburg
| | - Beate Hippchen
- Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Karl Egger
- Department of Neuroradiology, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
| | - Marcia Machein
- Department of Neurosurgery, University Medical Center Freiburg, Breisacher Str. 64, 79106 Freiburg, Germany
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24
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Extracranial growth of glioblastoma multiforme. J Clin Neurosci 2015; 22:1521-3. [PMID: 25956620 DOI: 10.1016/j.jocn.2015.03.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/20/2015] [Accepted: 03/03/2015] [Indexed: 11/23/2022]
Abstract
We present a 59-year-old woman who noted an enlarging lump on her forehead 6 months after a left frontotemporal craniotomy for tumor resection and chemoradiation of her primary glioblastoma multiforme (GBM). GBM is a highly aggressive intracranial neoplasm associated with the shortest survival time of any primary central nervous system malignancy. Extracranial metastasis is rare, especially without previous surgical disruption of the dura and calvarium, which has been postulated to cause seeding of the extracranial space with tumor cells. This patient's MRI revealed tumor recurrence for which she underwent repeat resection. Histopathology confirmed GBM with unmethylated O-6-methylguanine-DNA methyltransferase and wildtype isocitrate dehydrogenase 1 status, as well as tumor invasion through the bone and subdermal space. The genetic and molecular factors that predict extracranial invasion remain unclear and require further investigation. Emerging data on circulating tumor cells in GBM patients indicate that extraaxial metastasis may be part of the disease course in some, particularly in long term survivors. Furthermore, the proximity of calvarial and scalp lesions to previous surgical sites and the time course in which they emerge after surgery suggests that iatrogenic seeding may also play a role in metastasis. With heightened awareness of the phenomenon, surgical strategies such as watertight approximation of the dura, bone flap replacement, or changing surgical instruments once the intradural component is complete may prove useful to prevent seeding. Prophylactic craniospinal irradiation may also be an appropriate tool in patients at high risk for metastasis, although this population is difficult to identify.
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25
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Kros JM, Mustafa DM, Dekker LJM, Sillevis Smitt PAE, Luider TM, Zheng PP. Circulating glioma biomarkers. Neuro Oncol 2014; 17:343-60. [PMID: 25253418 DOI: 10.1093/neuonc/nou207] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 07/13/2014] [Indexed: 02/06/2023] Open
Abstract
Validated biomarkers for patients suffering from gliomas are urgently needed for standardizing measurements of the effects of treatment in daily clinical practice and trials. Circulating body fluids offer easily accessible sources for such markers. This review highlights various categories of tumor-associated circulating biomarkers identified in blood and cerebrospinal fluid of glioma patients, including circulating tumor cells, exosomes, nucleic acids, proteins, and oncometabolites. The validation and potential clinical utility of these biomarkers is briefly discussed. Although many candidate circulating protein biomarkers were reported, none of these have reached the required validation to be introduced for clinical practice. Recent developments in tracing circulating tumor cells and their derivatives as exosomes and circulating nuclear acids may become more successful in providing useful biomarkers. It is to be expected that current technical developments will contribute to the finding and validation of circulating biomarkers.
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Affiliation(s)
- Johan M Kros
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., P.-P.Z.); Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands (L.J.M.D., P.A.E.S.S., T.M.L.); Brain Tumor Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., L.J.M.D., P.A.E.S.S., T.M.L., P.-P.Z.)
| | - Dana M Mustafa
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., P.-P.Z.); Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands (L.J.M.D., P.A.E.S.S., T.M.L.); Brain Tumor Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., L.J.M.D., P.A.E.S.S., T.M.L., P.-P.Z.)
| | - Lennard J M Dekker
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., P.-P.Z.); Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands (L.J.M.D., P.A.E.S.S., T.M.L.); Brain Tumor Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., L.J.M.D., P.A.E.S.S., T.M.L., P.-P.Z.)
| | - Peter A E Sillevis Smitt
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., P.-P.Z.); Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands (L.J.M.D., P.A.E.S.S., T.M.L.); Brain Tumor Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., L.J.M.D., P.A.E.S.S., T.M.L., P.-P.Z.)
| | - Theo M Luider
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., P.-P.Z.); Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands (L.J.M.D., P.A.E.S.S., T.M.L.); Brain Tumor Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., L.J.M.D., P.A.E.S.S., T.M.L., P.-P.Z.)
| | - Ping-Pin Zheng
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., P.-P.Z.); Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands (L.J.M.D., P.A.E.S.S., T.M.L.); Brain Tumor Center Rotterdam, Erasmus Medical Center, Rotterdam, The Netherlands (J.M.K., D.M.M., L.J.M.D., P.A.E.S.S., T.M.L., P.-P.Z.)
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26
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Khan MB, Riaz M, Bari ME. Is surgical spinal decompression for supratentorial GBM symptomatic drop down metastasis warranted? A case report and review of literature. Surg Neurol Int 2014; 5:40. [PMID: 24818047 PMCID: PMC4014827 DOI: 10.4103/2152-7806.129558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 02/17/2014] [Indexed: 11/13/2022] Open
Abstract
Background: Symptomatic spinal metastasis from an intracranial primary glioblastoma multiforme (GBM) is very rare. Our literature search identified a total of 42 such patients of which 11 were treated with surgical decompression for spinal metastasis with only one such report from the pediatric age group. Previous studies have reported variable outcomes after surgical management. Case Description: We report the case of a 16-year-old boy who underwent surgical spinal decompression for spinal metastasis after intracranial GBM. The patient regained motor and autonomic function following surgery and reported improvement in pain. We also present findings from a literature review using the PubMed database from 1985 to June 2013 on this subject and compare radiation therapy with surgical decompression as palliative modalities in such patients. Conclusion: There are no evidence-based guidelines available on the subject and no treatment regimen has yet demonstrated survival benefit in these patients. Surgical decompression may be a better option for patients with focal resectable lesions and who are medically stable to tolerate the procedure.
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Affiliation(s)
- Muhammad Babar Khan
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Riaz
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Ehsan Bari
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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27
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Imaging guidelines and findings of extracranial glioblastoma. J Neurooncol 2014; 118:9-18. [DOI: 10.1007/s11060-014-1404-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/12/2014] [Indexed: 11/25/2022]
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Romero-Rojas AE, Diaz-Perez JA, Amaro D, Lozano-Castillo A, Chinchilla-Olaya SI. Glioblastoma metastasis to parotid gland and neck lymph nodes: fine-needle aspiration cytology with histopathologic correlation. Head Neck Pathol 2013; 7:409-15. [PMID: 23637061 PMCID: PMC3824794 DOI: 10.1007/s12105-013-0448-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/26/2013] [Indexed: 11/24/2022]
Abstract
Glioblastoma (GBM) is one of the most highly aggressive neoplasms of the central nervous system. Extra-cranial metastases in GBM are rare. Here we present the case of a 26-year-old man with extra-cranial metastasis of a frontal lobe GBM to the parotid gland, cervical lymph nodes, and bones, with initial diagnosis made by fine needle aspiration cytology (FNAC) of the parotid gland. FNAC is a reliable technique in the study of primary and secondary parotid gland neoplasms, allowing a presumptive diagnosis in difficult cases. We correlate the cytologic, histopathologic, and immunohistochemical findings in this case and discuss previous literature reports.
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Affiliation(s)
| | - Julio A. Diaz-Perez
- />National Institute of Cancer, Bogotá, Colombia , />University of California, San Diego, Stein Clinical Research Building 245, 9500 Gilman Drive, La Jolla, CA 92093-0637 USA , />University of Santander, Bucaramanga, Colombia
| | - Deirdre Amaro
- />University of California, San Diego, Stein Clinical Research Building 245, 9500 Gilman Drive, La Jolla, CA 92093-0637 USA
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