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Webb LM, Webb MJ, Campian JL, Caron SJ, Ruff MW, Uhm JH, Sener U. A case series of osseous metastases in patients with glioblastoma. Medicine (Baltimore) 2024; 103:e38794. [PMID: 38968484 PMCID: PMC11224798 DOI: 10.1097/md.0000000000038794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/12/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Extracranial metastases occur in <2% of cases of glioblastoma (GBM). When metastases do occur, bone is the most common destination. Herein, we review clinical characteristics of GBM patients with osseous metastases and evaluate both potential risk factors and prognostic significance. METHODS Using an institutional database, we identified and retrospectively analyzed 6 patients with both GBM and osseous metastases. We collected data on patient demographics, tumor genetics, clinical courses, and outcomes. Given the rarity of metastatic GBM, we conducted historical comparisons using previously published literature. RESULTS Five patients with osseous metastases (83%) were male, with a median age of 46 years at GBM diagnosis (range: 20-84). All patients had IDH-wildtype, MGMT promoter unmethylated GBM and 5 (83%) had alterations in TP53. All patients underwent surgical resection for GBM followed by radiation with concurrent and adjuvant temozolomide. Four patients (67%) received bevacizumab prior to bone metastasis diagnosis. Bone metastases were discovered at a median of 12.2 months (range: 5.3-35.2) after GBM diagnosis and 4.8 months after starting bevacizumab (range: 3.5-13.2). Three patients (50%) received immunotherapy. After osseous metastasis diagnosis, the median survival was 25 days (range: 13-225). CONCLUSION In our cohort, most patients were male and young at the time of GBM diagnosis. All patients had IDH-wildtype, MGMT promoter unmethylated GBM, and most had alterations in TP53, which may be important for osseous metastasis. Most patients received bevacizumab, which has been associated with earlier metastasis. Osseous metastases of GBM occur and portend a dismal prognosis in an already aggressive malignancy.
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Affiliation(s)
| | - Mason J. Webb
- Department of Hematology/Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jian L. Campian
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Samantha J. Caron
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael W. Ruff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Joon H. Uhm
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ugur Sener
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Knittel R, Rogers S, Wood BA. Cutaneous Seeding of Glioblastoma: A Case Report and Literature Review. Am J Dermatopathol 2024:00000372-990000000-00362. [PMID: 38842394 DOI: 10.1097/dad.0000000000002748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
ABSTRACT We present the case of a 61-year-old male patient with a history of intracranial IDH-wildtype glioblastoma with an isolated cutaneous metastasis within the previous surgical site scar. The cytomorphology of the cutaneous deposits was reminiscent of metastatic melanoma, which is a differential diagnostic pitfall. The tumor molecular characteristics are described, as these have become essential diagnostic criteria for many central nervous system tumors, along with a discussion of the role of immunohistochemical markers and potential pitfalls in the differential diagnosis of melanoma and poorly differentiated carcinoma. We discuss the biology of metastatic glioblastoma and provide a focused literature review of previous glioblastomas with tumor cell seeding within prior surgical scars.
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Affiliation(s)
- Ronan Knittel
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia; and
| | - Sasha Rogers
- Neurosurgery Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Benjamin A Wood
- Anatomical Pathology, PathWest, QEII Medical Centre, Nedlands, WA, Australia; and
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3
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Kurdi M, Baeesa S, Okal F, Bamaga AK, Faizo E, Fathaddin AA, Alkhotani A, Karami MM, Bahakeem B. Extracranial metastasis of brain glioblastoma outside CNS: Pathogenesis revisited. Cancer Rep (Hoboken) 2023; 6:e1905. [PMID: 37814403 PMCID: PMC10728524 DOI: 10.1002/cnr2.1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The most prevalent malignant tumor of the CNS in adults is glioblastoma. Despite undergoing surgery and chemoradiotherapy, the prognosis remains unfavorable, with a median survival period ranging between 15 and 20 months. The incidence of glioblastoma metastasis outside CNS is uncommon with only 0.4%-2% reported rate, compared to other tumors that exhibit a 10% incidence rate of metastasis to the brain. On average, it takes about 11 months from the time of initial diagnosis for the tumor to spread beyond CNS. Consequently, the prognosis for metastatic glioblastoma is grim, with a 6-month survival rate following diagnosis. FINDINGS The rarity of extracranial metastasis is attributed to the blood-brain barrier and lack of a lymphatic drainage system, although rare cases of hematogenous spread and direct implantation have been reported. The possible mechanisms remain unclear and require further investigation. Risk factors have been widely described, including previous craniotomy or biopsies, ventricular shunting, young age, radiation therapy, prolonged survival time, and tumor recurrence. Due to the lack of understanding about extracranial metastasis of glioblastoma pathogenesis, no effective treatment exists to date. Aggressive chemotherapies are not recommended for metastatic glioblastoma as their side effects may worsen the patient prognosis. CONCLUSION The optimal treatment for extracranial metastasis of glioblastoma requires further investigation with a wide inclusion of patients. This review discusses the possible causes, factors, and underlying mechanisms of glioblastoma metastasis to different organs.
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Affiliation(s)
- Maher Kurdi
- Department of Pathology, Faculty of MedicineKing Abdulaziz UniversityRabighSaudi Arabia
| | - Saleh Baeesa
- Department of NeurosciencesKing Faisal Specialist Hospital and Research CenterJeddahSaudi Arabia
| | - Fahad Okal
- Department of Neuroscience, Neurosurgery Section, King Abdulaziz Medical CityNational Guard Health AffairsJeddahSaudi Arabia
| | - Ahmed K. Bamaga
- Department of Paediatric, Faculty of MedicineKing Abdulaziz University and HospitalJeddahSaudi Arabia
| | - Eyad Faizo
- Department of Surgery, Faculty of MedicineUniversity of TabukTabukSaudi Arabia
| | - Amany A. Fathaddin
- Department of Pathology, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Alaa Alkhotani
- Department of Pathology, College of MedicineUmm Al‐Qura UniversityMeccaSaudi Arabia
| | - Mohammed M. Karami
- Department of Clinical Physiology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Basem Bahakeem
- Department of Internal MedicineUmm‐Alqura UniversityMeccaSaudi Arabia
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4
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Aymeric A, Louis-Marie T, Gabrielle C, Vincent J, Benoit M, Romuald S, Evelyne E, Luc B, Vincent R, Jimmy V, Christophe J, Emmanuel M, Leslie L, Bertrand M, Pierre-Jean LR, Andres C, Antoine P, Valérie R, Karima M, Audrey R, Philippe M, Dominique FB, Guillaume G, Kaissar F, Johan P, Ilyess Z. Natural history of spinal cord metastasis from brain glioblastomas. J Neurooncol 2023; 162:373-382. [PMID: 36991306 DOI: 10.1007/s11060-023-04298-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Spinal cord metastasis arising from an intracranial glioblastoma is a rare and late event during the natural course of the disease. These pathological entities remain poorly characterized. This study aimed to identify and investigate the timeline, clinical and imaging findings, and prognostic factors of spinal cord metastasis from a glioblastoma. METHODS Consecutive histopathological cases of spinal cord metastasis from glioblastomas in adults entered in the French nationwide database between January 2004 and 2016 were screened. RESULTS Overall, 14 adult patients with a brain glioblastoma (median age 55.2 years) and harboring a spinal cord metastasis were included. The median overall survival as 16.0 months (range, 9.8-22.2). The median spinal cord Metastasis Free Survival (time interval between the glioblastoma diagnosis and the spinal cord metastasis diagnosis) was 13.6 months (range, 0.0-27.9). The occurrence of a spinal cord metastasis diagnosis greatly impacted neurological status: 57.2% of patients were not ambulatory, which contributed to dramatically decreased Karnofsky Performance Status (KPS) scores (12/14, 85.7% with a KPS score ≤ 70). The median overall survival following spinal cord metastasis was 3.3 months (range, 1.3-5.3). Patients with a cerebral ventricle effraction during the initial brain surgery had a shorter spinal cord Metastasis Free Survival (6.6 vs 18.3 months, p = 0.023). Out of the 14 patients, eleven (78.6%) had a brain IDH-wildtype glioblastoma. CONCLUSIONS Spinal cord metastasis from a brain IDH-wildtype glioblastoma has a poor prognosis. Spinal MRI can be proposed during the follow-up of glioblastoma patients especially those who have benefited from cerebral surgical resection with opening of the cerebral ventricles.
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Affiliation(s)
- Amelot Aymeric
- Department of Neurosurgery, CHRU de Tours, Tours, France.
- Service de Neurochirurgie, CHRU Bretonneau, 2 Boulevard Tonnellé, Tours Cedex 9, 37044, Tours, France.
| | - Terrier Louis-Marie
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | - Cognacq Gabrielle
- University of Oxford, John Radcliffe HospitalHeadley Way, Headington, Oxford, OX3 9DU, Oxfordshire, United Kingdom
| | - Jecko Vincent
- Department of Neurosurgery A, CHU Pellegrin, Bordeaux, France
| | | | - Seizeur Romuald
- Department of Neurosurgery, CHU de La Cavale Blanche, Brest, France
| | - Emery Evelyne
- Department of Neurosurgery, CHU de Caen, Caen, France
| | - Bauchet Luc
- Department of Neurosurgery, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France
| | | | - Voirin Jimmy
- Department of Neurosurgery, Pasteur Hospital, HCC, Colmar, France
| | | | | | - Lemnos Leslie
- Department of Neurosurgery, CHU Dupuytren, Limoges, France
| | - Mathon Bertrand
- Department of Neurosurgery, CHU Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | | | - Coca Andres
- Department of Neurosurgery, CHU Strasbourg, Strasbourg, France
| | - Petit Antoine
- Department of Neurosurgery, CHU Jean-Minjoz, Besançon, France
| | - Rigau Valérie
- Department of Neuropathology, CHU Gui de Chauliac, Montpellier, France
| | - Mokhtari Karima
- Department of Neuropathology, Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Metellus Philippe
- Department of Neurosurgery, Clairval Private Hospital, Ramsay Generale de Sante, Marseille, France
| | | | | | - Farah Kaissar
- Department of Neurosurgery, CHU La Timone, Marseille, France
| | - Pallud Johan
- Department of Neurosurgery, GHU-Paris Psychiatrie Et Neurosciences, Hôpital Sainte-Anne, Paris, France
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Wang F, Dong J, Zhang J, Zhao H, Wang N, Jin J, Yan X, Gao X, Liu H, Hu S. Rapid progression of subcutaneous glioblastoma: A case report and literature review. Front Oncol 2023; 13:935944. [PMID: 36761958 PMCID: PMC9905810 DOI: 10.3389/fonc.2023.935944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Extra-neural spread of glioblastoma (GBM) is extremely rare. We report a case of postoperative intracranial GBM spreading to the subcutaneous tissue via the channel of craniotomy defect in a 73-year-old woman. Radiological images and histopathology indicate that the tumor microenvironment of the subcutaneous tumor is clearly different from the intracranial tumor. We also model the invasion of GBM cells through the dura-skull defect in mouse. The retrospective analysis of GBM with scalp metastases suggests that craniectomy is a direct cause of subcutaneous metastasis in patients with GBM. Imaging examinations of other sites for systemic screening is also recommended to look for metastases outside the brain when GBM invades the scalp or metastasizes to it.
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Affiliation(s)
- Fang Wang
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiawei Dong
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiheng Zhang
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hongtao Zhao
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Wang
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jiaqi Jin
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiuwei Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Han Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Shaoshan Hu, ; Han Liu,
| | - Shaoshan Hu
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China,*Correspondence: Shaoshan Hu, ; Han Liu,
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6
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Veerwal H, Meena A, Dhingra V. A Case of Extracranial Metastasis of Glioblastoma Multiforme Seen on Bone Scintigraphy. Mol Imaging Radionucl Ther 2022; 31:246-249. [PMID: 36268939 PMCID: PMC9586011 DOI: 10.4274/mirt.galenos.2021.09815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system in adults. It is known for its devastating intracranial progress thus attributing to its very short survival. Here, we report a case of 37-year-old female with GBM post surgery, chemotherapy and radiotherapy who presented with pain in right hip region. She was referred to our department for evaluation of skeletal metastasis. Tc-99m methylene diphosphonate bone scan revealed an expansile lesion involving the right iliac blade along with extensive lytic bony lesions throughout the axial skeleton.
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Affiliation(s)
- Hardik Veerwal
- All India Institute of Medical Sciences, Department of Nuclear Medicine, Rishikesh, India
| | - Anjali Meena
- All India Institute of Medical Sciences, Department of Nuclear Medicine, Rishikesh, India
| | - Vandana Dhingra
- All India Institute of Medical Sciences, Department of Nuclear Medicine, Rishikesh, India
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7
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Labak CM, Rabah NM, Kipke JP, Mahajan UV, Labak KB, Ali SA, Fowler N, Sloan AE. Multidisciplinary approaches to gliosarcoma: A case report and review of the literature. Clin Case Rep 2022; 10:e5985. [PMID: 36017117 PMCID: PMC9396286 DOI: 10.1002/ccr3.5985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
A 58‐year‐old right‐handed man presented to our tertiary care center with gliosarcoma (GS) infiltration through the dura, skull, and soft tissue. Patient had a previous history of right temporal GS, with four intracranial surgeries prior to presentation. A multidisciplinary approach was used to treat the lesion and perform reconstruction.
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Affiliation(s)
- Collin M. Labak
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Nicholas M. Rabah
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Jasmine P. Kipke
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Uma V. Mahajan
- Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | - S. Ahmed Ali
- Department of Otolaryngology University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Nicole Fowler
- Department of Otolaryngology University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
- Seidman Cancer Center and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Andrew E. Sloan
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
- Seidman Cancer Center and Case Comprehensive Cancer Center Cleveland Ohio USA
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8
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Zapata Laguado M, Baez JM, Luna A, Mantilla C, Palencia M. Bone Metastasis From Glioblastoma Multiforme: A Case Report. Cureus 2022; 14:e25464. [PMID: 35800795 PMCID: PMC9246435 DOI: 10.7759/cureus.25464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/05/2022] Open
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9
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Bone metastasis from glioblastoma: a systematic review. J Neurooncol 2022; 158:379-392. [PMID: 35578056 DOI: 10.1007/s11060-022-04025-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Glioblastoma (GBM) is a devastating disease with poor overall survival. Despite the common occurrence of GBM among primary brain tumors, metastatic disease is rare. Our goal was to perform a systematic literature review on GBM with osseous metastases and understand the rate of metastasis to the vertebral column as compared to the remainder of the skeleton, and how this histology would fit into our current paradigm of treatment for bone metastases. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant literature search was performed using the PubMed database from 1952 to 2021. Search terms included "GBM", "glioblastoma", "high-grade glioma", "bone metastasis", and "bone metastases". RESULTS Of 659 studies initially identified, 67 articles were included in the current review. From these 67 articles, a total of 92 distinct patient case presentations of metastatic glioblastoma to bone were identified. Of these cases, 58 (63%) involved the vertebral column while the remainder involved lesions within the skull, sternum, rib cage, and appendicular skeleton. CONCLUSION Metastatic dissemination of GBM to bone occurs. While the true incidence is unknown, workup for metastatic disease, especially involving the spinal column, is warranted in symptomatic patients. Lastly, management of patients with GBM vertebral column metastases can follow the International Spine Oncology Consortium two-step multidisciplinary algorithm for the management of spinal metastases.
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10
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Nakib CE, Hajjar R, Zerdan MB, Darwish H, Zeidan Y, Alame S, Kassouf HK, Chamseddine N, Assi HI. Glioblastoma multiforme metastasizing to the skin, a case report and literature review. Radiol Case Rep 2021; 17:171-175. [PMID: 34815821 PMCID: PMC8593264 DOI: 10.1016/j.radcr.2021.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 01/24/2023] Open
Abstract
Glioblastoma Multiforme (GBM) is the most common primary central nervous system (CNS) malignancy in adults. It is very aggressive and is notorious for its fast and local invasion of nearby brain parenchyma. Consequently, the overall survival (OS) of patients with GBM is short despite resection, radiotherapy and chemotherapy regimens. The most common sites of metastasis of GBM are the lungs and pleura, cervical lymph nodes, and bone. Metastasis to the skin is a rare event and to our knowledge, there are less than 30 cases of GBM metastasizing to cutaneous or subcutaneous tissue described in the literature. None of these cases were diagnosed and/or treated in the Middle East region; and the majority of the metastases found were adjacent to the site of surgery undergone to remove the primary malignancy. We present the case of a 53-year-old male diagnosed with GBM and later showing signs of metastases at the anterio-auricular side of his face near-distant from the site of previous surgery done to remove the primary tumor.
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Affiliation(s)
- Clara El Nakib
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Hajjar
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Darwish
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Youssef Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saada Alame
- Department of Pediatrics, Lebanese University, Beirut, Lebanon
| | - Hala Kfoury Kassouf
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nathalie Chamseddine
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hazem I. Assi
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon,Corresponding author
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11
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Zhang X, Katsakhyan L, LiVolsi VA, Roth JJ, Rassekh CH, Bagley SJ, Nasrallah MP. TP53 Mutation and Extraneural Metastasis of Glioblastoma: Insights From an Institutional Experience and Comprehensive Literature Review. Am J Surg Pathol 2021; 45:1516-1526. [PMID: 34366423 DOI: 10.1097/pas.0000000000001762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Extraneural metastases of glioblastoma (GBM), although rare, are becoming an increasingly recognized occurrence. Currently, the biological mechanism underlying this rare occurrence is not understood. To explore the potential genomic drivers of extraneural metastasis in GBM, we present the molecular features of 4 extraneural metastatic GBMs, along with a comprehensive review and analysis of previously reported cases that had available molecular characterization. In addition to our 4 cases, 42 patients from 35 publications are reviewed. To compare the molecular profiles between GBM cases with extraneural metastasis and the general GBM population, genomic data from GBM samples in The Cancer Genome Atlas (TCGA) database were also analyzed. We found that 64.5% (20/31) of the cases with extraneural metastasis that were tested for TP53 changes had at least 1 TP53 pathogenic variant detected in either 1 or both primary and metastatic tumors. In contrast, TP53 mutation was significantly less frequent in the unselected GBM from TCGA (22.6%, 56/248) (P=0.000). In addition, O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation was more common in unselected TCGA GBM cases (48.6%, 170/350) than in cases with extraneural metastasis (31.8%, 7/22), although not statistically significant. Although isocitrate dehydrogenase (IDH) mutation is a rare occurrence in high-grade astrocytomas, IDH-mutant grade 4 astrocytomas are at least as likely to metastasize as IDH wild-type GBMs; 3 metastatic cases definitively harbored an IDH1 (p.R132H) mutation in our analysis. Our findings not only provide potential biomarkers for earlier screening of extraneural metastasis, but could also suggest clues to understanding biological mechanisms underlying GBM metastasis, and for the development of therapeutic modalities.
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Affiliation(s)
| | | | | | | | | | - Stephen J Bagley
- Hematology Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
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12
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Nussbaum E, Graupman P, Lacey M, Harrison A, Lowary J, Touchette J, Nussbaum L. Transport of patients with giant disfiguring cranial tumors from Africa to the US for collaborative multidisciplinary treatment. Surg Neurol Int 2021; 12:175. [PMID: 34084603 PMCID: PMC8168801 DOI: 10.25259/sni_923_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/05/2021] [Indexed: 11/04/2022] Open
Abstract
Background Giant disfiguring cranial tumors are exceptionally rare and develop over the course of many years, typically in patients who lack access to medical care. Here, we describe four patients who were flown to our center for treatment by a multidisciplinary surgical team, who had previously been turned down for treatment at multiple international centers in Africa, Europe, and the United States (US) due to complexity and financial concerns. The case series describes socioeconomic implications and the feasibility of offering such care to patients from outside the US. Case Descriptions Four patients with giant skull disfiguring tumors were flown internationally and treated by a surgical team consisting of a complex cranial neurosurgeon, a craniofacial reconstructive plastic surgeon, and an oculoplastic surgeon. All patients underwent aggressive surgical therapy with the aim of complete tumor removal and simultaneous cranial reconstruction. A patient with osteogenic sarcoma underwent two additional resections in 3 years, with delayed reconstruction. They returned home but ultimately succumbed to the disease. A patient with ossifying fibroma required two follow-up procedures for cosmetic reconstruction and sought asylum in the US, where they remain today. Two additional patients, one with a giant plexiform neurofibroma and one with a cerebellopontine angle meningioma, achieved good results and returned to Africa 1 month and 3 weeks after surgery, respectively. Conclusion Resection of giant disfiguring cranial tumors and reconstruction of the impacted region requires an experienced multidisciplinary team. These cases can be managed by transporting such patients from areas without access to medical care to specialized centers able to provide excellent care.
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Affiliation(s)
- Eric Nussbaum
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, Minneapolis, Minnesota, United States
| | - Patrick Graupman
- Department of Neurosurgery, Gillette Children's Specialty Healthcare, Saint Paul, Minnesota, United States
| | - Martin Lacey
- Department of Craniofacial and Plastic Surgery, Gillette Children's Specialty Healthcare, Saint Paul, Minnesota, United States
| | - Andrew Harrison
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, United States
| | - Jodi Lowary
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, Minneapolis, Minnesota, United States
| | | | - Leslie Nussbaum
- Department of Neurosurgery, National Brain Aneurysm and Tumor Center, Minneapolis, Minnesota, United States
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13
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Liu J, Shen L, Tang G, Tang S, Kuang W, Li H, Tian Y, Zhou Q. Multiple extracranial metastases from glioblastoma multiforme: a case report and literature review. J Int Med Res 2021; 48:300060520930459. [PMID: 32552287 PMCID: PMC7303784 DOI: 10.1177/0300060520930459] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Extracranial metastasis from glioblastoma multiforme (GBM) is rare, especially
multi-site metastases without intracranial recurrence. However, the metastatic
mechanism of GBM remains unknown and there is currently no consensus regarding
the best therapeutic regimen. We report the case of a 46-year-old man with
primary GBM who developed scalp metastases and subsequent multiple pulmonary
metastases. He was treated with the Stupp regimen after surgery for the
intracranial tumor. However, a series of soft masses in the scalp were
subsequently identified, and new nodules were found in his left eyebrow arch
during chemoradiotherapy. Despite salvage chemotherapy and targeted therapy, the
patient eventually died of respiratory failure with multiple pulmonary
metastases. This case highlights the need for rigorous follow-up, including
brain magnetic resonance imaging, in patients with GBM. The occurrence of
extra-central nervous system symptoms indicates the possibility of metastasis,
and the relevant examinations should be conducted promptly. Positive therapies
may help to relieve symptoms and prolong survival in patients with metastatic
GBM.
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Affiliation(s)
- Jing Liu
- Department of Oncology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
| | - Guyu Tang
- Department of Urology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
| | - Siyuan Tang
- Department of Oncology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
| | - Weilu Kuang
- Department of Oncology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
| | - Huan Li
- Department of Oncology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
| | - Yifu Tian
- Department of Pathology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
| | - Qin Zhou
- Department of Oncology, Xiangya Hospital, Central South
University, Changsha, Hunan Province, People’s Republic of China
- Qin Zhou, Department of Oncology, Xiangya
Hospital, Central South University, No. 87, Xiangya Road, Kaifu District,
Changsha, Hunan Province 410008, China.
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14
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Gribaudi GL, Pirola E, Borsa S, Del Bene M, Sgardello S, Caroli M. Multiple vertebral metastases from brain glioblastoma: An insidious complication. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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15
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Valdebenito S, D'Amico D, Eugenin E. Novel approaches for glioblastoma treatment: Focus on tumor heterogeneity, treatment resistance, and computational tools. Cancer Rep (Hoboken) 2019; 2:e1220. [PMID: 32729241 PMCID: PMC7941428 DOI: 10.1002/cnr2.1220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 06/05/2019] [Accepted: 07/02/2019] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) is a highly aggressive primary brain tumor. Currently, the suggested line of action is the surgical resection followed by radiotherapy and treatment with the adjuvant temozolomide, a DNA alkylating agent. However, the ability of tumor cells to deeply infiltrate the surrounding tissue makes complete resection quite impossible, and, in consequence, the probability of tumor recurrence is high, and the prognosis is not positive. GBM is highly heterogeneous and adapts to treatment in most individuals. Nevertheless, these mechanisms of adaption are unknown. RECENT FINDINGS In this review, we will discuss the recent discoveries in molecular and cellular heterogeneity, mechanisms of therapeutic resistance, and new technological approaches to identify new treatments for GBM. The combination of biology and computer resources allow the use of algorithms to apply artificial intelligence and machine learning approaches to identify potential therapeutic pathways and to identify new drug candidates. CONCLUSION These new approaches will generate a better understanding of GBM pathogenesis and will result in novel treatments to reduce or block the devastating consequences of brain cancers.
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Affiliation(s)
- Silvana Valdebenito
- Department of Neuroscience, Cell Biology, and AnatomyUniversity of Texas Medical Branch (UTMB)GalvestonTexas
| | - Daniela D'Amico
- Department of Neuroscience, Cell Biology, and AnatomyUniversity of Texas Medical Branch (UTMB)GalvestonTexas
- Department of Biomedicine and Clinic NeuroscienceUniversity of PalermoPalermoItaly
| | - Eliseo Eugenin
- Department of Neuroscience, Cell Biology, and AnatomyUniversity of Texas Medical Branch (UTMB)GalvestonTexas
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16
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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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17
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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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18
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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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19
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Carvalho JADV, Barbosa CCDL, Feher O, Maldaun MVC, Camargo VPD, Moraes FY, Marta GN. Systemic dissemination of glioblastoma: literature review. ACTA ACUST UNITED AC 2019; 65:460-468. [PMID: 30994848 DOI: 10.1590/1806-9282.65.3.460] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Glioblastoma (GBM) is the most frequent primary malignant tumor from the central nervous system in adults. However, the presence of systemic metastasis is an extremely rare event. The objective of this study was to review the literature, evaluating the possible biological mechanisms related to the occurrence of systemic metastasis in patients diagnosed with GBM. RESULTS The mechanisms that may be related to GBM systemic dissemination are the blood-brain barrier breach, often seen in GBM cases, by the tumor itself or by surgical procedures, gaining access to blood and lymphatic vessels, associated with the acquisition of mesenchymal features of invasiveness, resistance to the immune mechanisms of defense and hostile environment through quiescence. CONCLUSIONS Tumor cells must overcome many obstacles until the development of systemic metastasis. The physiologic mechanisms are not completely clear. Although not fully understood, the pathophysiological understanding of the mechanisms that may be associated with the systemic spread is salutary for a global understanding of the disease. In addition, this knowledge may be used as a basis for a therapy to be performed in patients diagnosed with GBM distant metastasis.
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Affiliation(s)
| | - Caroline Chaul de Lima Barbosa
- Department of Radiology and Oncology - Clinical Oncology Unit; Faculdade de Medicina da Universidade de São Paulo - Instituto do Câncer do Estado de São Paulo (Icesp); Sao Paulo, Brasil.,Department of Clinical Oncology - Hospital Sírio-Libanês; Sao Paulo, Brasil
| | - Olavo Feher
- Department of Radiology and Oncology - Clinical Oncology Unit; Faculdade de Medicina da Universidade de São Paulo - Instituto do Câncer do Estado de São Paulo (Icesp); Sao Paulo, Brasil.,Department of Clinical Oncology - Hospital Sírio-Libanês; Sao Paulo, Brasil
| | - Marcos Vinicius Calfat Maldaun
- Division of Neurosurgery, Hospital Sírio-Libanês; Sao Paulo, Brasil.,Division of Neurosurgery, Santa Paula Hospital, São Paulo, SP, Brasil
| | - Veridiana Pires de Camargo
- Department of Radiology and Oncology - Clinical Oncology Unit; Faculdade de Medicina da Universidade de São Paulo - Instituto do Câncer do Estado de São Paulo (Icesp); Sao Paulo, Brasil.,Department of Clinical Oncology - Hospital Sírio-Libanês; Sao Paulo, Brasil
| | - Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Queen's University - Kingston Health Science Centre, Kingston, ON, Canada.,Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brasil
| | - Gustavo Nader Marta
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (Icesp), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brasil.,Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brasil
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20
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Kirkman MA, Pickles JC, Fairchild AR, Avery A, Pietsch T, Jacques TS, Aquilina K. Early Wound Site Seeding in a Patient with Central Nervous System High-Grade Neuroepithelial Tumor with BCOR Alteration. World Neurosurg 2018; 116:279-284. [PMID: 29859355 DOI: 10.1016/j.wneu.2018.05.158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/21/2018] [Accepted: 05/23/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Advances in molecular profiling have facilitated the emergence of newly defined entities of central nervous system (CNS) tumor, including CNS high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR). Relatively little is known about the clinical behavior of these newly characterized tumors. CASE DESCRIPTION We describe a pediatric male patient with CNS HGNET-BCOR, who developed seeding of the tumor into the site of the surgical wound within months of surgery and who underwent resection of a residual posterior fossa tumor. CONCLUSIONS This case emphasizes 3 important points. First, CNS HGNET-BCOR can be aggressive tumors that necessitate close clinical and radiologic surveillance. Second, surveillance imaging in such cases should incorporate the surgical incision site into the field of view, and this should be closely scrutinized to ensure the timely detection of wound site seeding. Third, wound site seeding may still occur despite the use of meticulous surgical techniques.
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Affiliation(s)
- Matthew A Kirkman
- Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom; Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Jessica C Pickles
- Department of Histopathology, Great Ormond Street Hospital, London, United Kingdom; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Amy R Fairchild
- Department of Histopathology, Great Ormond Street Hospital, London, United Kingdom; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Aimee Avery
- Department of Histopathology, Great Ormond Street Hospital, London, United Kingdom; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Torsten Pietsch
- Department of Neuropathology and Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany
| | - Thomas S Jacques
- Department of Histopathology, Great Ormond Street Hospital, London, United Kingdom; Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom.
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21
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Harrison RA, Nam JY, Weathers SP, DeMonte F. Intracranial dural, calvarial, and skull base metastases. HANDBOOK OF CLINICAL NEUROLOGY 2018; 149:205-225. [PMID: 29307354 DOI: 10.1016/b978-0-12-811161-1.00014-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Metastatic disease to the intracranial dura, the calvarium, and the skull base is relatively uncommon but presents unique diagnostic and management challenges in the patient with cancer. Modern imaging techniques have facilitated the detection of intracranial tumor deposits, leading to increased incidence. While dural and calvarial metastases often present with nonspecific symptoms, skull base metastases present with distinct clinical syndromes dependent on the local neurovascular structures affected. Intracranial dural metastases can often be confused with meningioma and pose a diagnostic challenge, as well as significant neurologic morbidity, especially in the setting of hemorrhage. Surgical intervention may be helpful in selected patients for symptomatic relief as well as survival benefit. Management paradigms need to take into account the relative risks, benefits, and likely outcomes for each possible modality of treatment. Surgical excision is useful in many patients and in combination with radiation therapy can provide significant palliation. While medical therapy is rarely an initial therapy in these entities, it may be of added benefit dependent on the underlying tumor histology and prior treatment history. Occasionally treatment with curative intent is justified.
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Affiliation(s)
- Rebecca A Harrison
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Joo Yeon Nam
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States
| | - Franco DeMonte
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, United States.
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22
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Taghipour Zahir S, Mortaz M, Baghi Yazdi M, Sefidrokh Sharahjin N, Shabani M. Calvarium mass as the first presentation of glioblastoma multiforme: A very rare manifestation of high-grade glioma. Neurochirurgie 2017; 64:76-78. [PMID: 29248175 DOI: 10.1016/j.neuchi.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/15/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
Glioblastoma multiforme (GBM) is a high grade glial tumor, primarily located in cerebral hemispheres. The most common clinical presentations are slowly progressive neurological deficit such as motor weakness, seizure, and headaches that last less than three months. Calvarium and extra-axial invasion are very rare and generally occur after a brain biopsy or surgery, or secondary to radiotherapy of primary intra-axial glial tumors. We report a case of GBM with calvarium involvement in a 60-year-old man who presented with a frontal bump and left-sided clumsiness. Imaging studies revealed a tumoral lesion that destroyed the frontal bone with white matter involvement of the frontal lobe and extension into the corpus callosum. Histopathological examination of intra-axial and extra-axial lesions revealed pleomorphic high-grade tumor with large areas of necrosis and hemorrhage. Immunohistochemical (IHC) studies confirmed GBM that spread directly into the dura, galea, and calvarium (positive reaction for GFAP, S-100, CD68, OLIG2, and p53). The patient was treated with radiotherapy (60Gy/30 fractions) and concomitant temozolomide. Unfortunately, the patient died seven months after the initial diagnosis.
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Affiliation(s)
- S Taghipour Zahir
- Department of pathology, School of Medicine, Shahid Sadoughi University of Medical Sciences, P.O. 8915173149, Daneshjoo street, Professor Hessabi BLV, Shohadaye Gomnam BLV, 89136 Yazd, Iran
| | - M Mortaz
- Department of pathology, School of Medicine, Shahid Sadoughi University of Medical Sciences, P.O. 8915173149, Daneshjoo street, Professor Hessabi BLV, Shohadaye Gomnam BLV, 89136 Yazd, Iran
| | - M Baghi Yazdi
- Department of pathology, School of Medicine, Shahid Sadoughi University of Medical Sciences, P.O. 8915173149, Daneshjoo street, Professor Hessabi BLV, Shohadaye Gomnam BLV, 89136 Yazd, Iran.
| | - N Sefidrokh Sharahjin
- Department of pathology, School of Medicine, Shahid Sadoughi University of Medical Sciences, P.O. 8915173149, Daneshjoo street, Professor Hessabi BLV, Shohadaye Gomnam BLV, 89136 Yazd, Iran
| | - M Shabani
- Department of pathology, School of Medicine, Shahid Sadoughi University of Medical Sciences, P.O. 8915173149, Daneshjoo street, Professor Hessabi BLV, Shohadaye Gomnam BLV, 89136 Yazd, Iran
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23
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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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24
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Ranjani S, Mehdi I, Sreenath C, Palassery R. Subcutaneous metastasis secondary to surgical tract seeding in a child with medulloblastoma - A case report. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2017.04.001] [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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