1
|
Tagle-Vega U, Patiño-Gómez JG, Abdalá-Vargas NJ, Pulido Bayona PA, Ordoñez-Rubiano EG. Symptomatic spinal metastasis of a supratentorial glioblastoma in a pediatric patient: a case report and comprehensive review of the literature. Neurochirurgie 2024; 70:101583. [PMID: 39047904 DOI: 10.1016/j.neuchi.2024.101583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/26/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
Spinal metastasis of Glioblastoma is a rare occurrence, especially in pediatric patients, and extremely rare to become symptomatic. The pathology is poorly understood and remains with unclear dissemination mechanisms. The treatment approaches are varied and multimodal therapy (surgery, chemotherapy, and radiotherapy) can be employed to manage this type of metastasis. We report a case of a 17-year-old female who underwent a gross-total resection of a right frontal glioblastoma and had adjuvant therapy with chemo- and radiotherapy. In the sixth month of follow-up, the patient presented a paraparesis, and a distant recurrence at T7-T8 was detected. The patient was treated with gross-total resection of the tumor through a laminectomy. The histopathological results were consistent with an isocitrate dehydrogenase (IDH) wildtype GBM metastasis. The patient was treated with multimodal therapy, including surgery, radiotherapy, and chemotherapy. A complementary comprehensive review of current available literature on this topic is also presented.
Collapse
Affiliation(s)
- Uriel Tagle-Vega
- Professional School of Human Medicine, Health Sciences Faculty, Universidad Andina del Cusco, Cusco, Peru; Research Unit, Pan-American Student Society of Neurosurgery and Neurosciences.
| | - Javier G Patiño-Gómez
- Department of Neurosurgery, Hospital Universitario Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Department of Neurosurgery, Hospital de San José - Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
| | - Nadin J Abdalá-Vargas
- Department of Neurosurgery, Hospital Universitario Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Department of Neurosurgery, Hospital de San José - Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
| | - Paula A Pulido Bayona
- Department of Neurosurgery, Hospital Universitario Infantil de San José, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Department of Neurosurgery, Hospital de San José - Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
| | - Edgar G Ordoñez-Rubiano
- Department of Neurosurgery, Hospital de San José - Sociedad de Cirugía de Bogotá, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia; Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Gu P, Ding Y, Zheng G, Xu P, Xia X. Extracranial metastasis of glioblastoma: A case report and literature review. Int J Surg Case Rep 2023; 111:108895. [PMID: 37812956 PMCID: PMC10568299 DOI: 10.1016/j.ijscr.2023.108895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Glioblastoma (GBM) is the most common malignant tumor of the central nervous system. Extracranial metastasis is rare, accounting for only 0.4 %-0.5 % of all GBM patients. The pathways and mechanisms involved are still unclear. CASE PRESENTATION We reported a rare case of GBM with multiple bone metastases, highly suspected of abdominal metastasis. This 20 year old woman underwent surgery in March 2017 and underwent postoperative radiotherapy and chemotherapy. In July 2018, she underwent a second surgery due to intracranial recurrence and also underwent radiotherapy and chemotherapy after the surgery. She experienced pain in the lumbosacral region in May 2019, abdominal magnetic resonance imaging (MRI) showed metastases to the ilium, sacrum, and multiple lumbar vertebrae. In August 2019, a lump was discovered at the sternum and biopsy was performed, pathological examination confirmed it as GBM. During this period, the patient's condition was briefly controlled after receiving palliative radiotherapy, chemotherapy, and targeted treatment. Surprisingly, the patient later developed highly suspected malignant ascites, and further anti-tumor treatment was refused. She died 7 months after diagnosis of extracranial metastases. CLINICAL DISCUSSION This patient with GBM had multiple bone metastases and highly suspected abdominal metastasis after two operations. Chemotherapy, radiotherapy and Targeted therapy extend the survival period and improve the quality of life. CONCLUSION We believe that the patient's extracranial metastases may have occurred through blood. Young "long-term survivors" who have undergone surgery seem to have a higher risk of extracranial metastasis. Timely detection and early treatment can improve the overall quality of life of the patient.
Collapse
Affiliation(s)
- Pei Gu
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Yongsheng Ding
- Department of Radiology, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Guihua Zheng
- Department of Pathology, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China
| | - Pengqin Xu
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China.
| | - Xiaochun Xia
- Department of Radiotherapy, Affiliated Tumor Hospital of Nantong University, Nantong Tumor Hospital, Nantong, China.
| |
Collapse
|
4
|
Karkon-Shayan S, Aliashrafzadeh H, Dianat-Moghadam H, Rastegar-Pouyani N, Majidi M, Zarei M, Moradi-Vastegani S, Bahramvand Y, Babaniamansour S, Jafarzadeh E. Resveratrol as an antitumor agent for glioblastoma multiforme: Targeting resistance and promoting apoptotic cell deaths. Acta Histochem 2023; 125:152058. [PMID: 37336070 DOI: 10.1016/j.acthis.2023.152058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
Glioblastoma multiforme (GBM) is one of the most aggressive brain and spinal cord tumors. Despite the significant development in application of antitumor drugs, no significant increases have been observed in the survival rates of patients with GBM, as GBM cells acquire resistance to conventional anticancer therapeutic agents. Multiple studies have revealed that PI3K/Akt, MAPK, Nanog, STAT 3, and Wnt signaling pathways are involved in GBM progression and invasion. Besides, biological processes such as anti-apoptosis, autophagy, angiogenesis, and stemness promote GBM malignancy. Resveratrol (RESV) is a non-flavonoid polyphenol with high antitumor activity, the potential of which, regulating signaling pathways involved in cancer malignancy, have been demonstrated by many studies. Herein, we present the potential of RESV in both single and combination therapy- targeting various signaling pathways- which induce apoptotic cell death, re-sensitize cancer cells to radiotherapy, and induce chemo-sensitizing effects to eventually inhibit GBM progression.
Collapse
Affiliation(s)
- Sepideh Karkon-Shayan
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Hasan Aliashrafzadeh
- Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hassan Dianat-Moghadam
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nima Rastegar-Pouyani
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Majidi
- Student Research Committee, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Mahdi Zarei
- Student Research Committee, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sadegh Moradi-Vastegani
- Department of physiology, faculty of medicine, physiology research center, Ahvaz jundishapur university of medical sciences, Ahvaz, Iran
| | - Yaser Bahramvand
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepideh Babaniamansour
- Department of Pathology, School of Medicine, Islamic Azad University Tehran Faculty of Medicine, Tehran, Iran
| | - Emad Jafarzadeh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
5
|
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.
Collapse
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
| | | |
Collapse
|
6
|
Matsuhashi A, Tanaka S, Takami H, Nomura M, Ikemura M, Matsubayashi Y, Shinoda Y, Yamada K, Sakai Y, Karasawa Y, Takayanagi S, Saito N. Recurrent glioblastoma metastatic to the lumbar vertebra: A case report and literature review: Surgical oncology. Front Oncol 2023; 13:1101552. [PMID: 36874120 PMCID: PMC9978767 DOI: 10.3389/fonc.2023.1101552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/31/2023] [Indexed: 02/18/2023] Open
Abstract
Background Glioblastoma is a malignant tumor, and its prognosis is as poor as 1.5 to 2 years. Most cases recur within one year even under the standard treatment. The majority of recurrences are local, and in rare cases, metastasize mostly within the centra nervous system. Extradural metastasis of glioma is exceedingly rare. Here, we present a case of vertebral metastasis of glioblastoma. Case presentation We present a 21-year-old man post total resection of the right parietal glioblastoma, diagnosed with lumbar metastasis. He originally presented with impaired consciousness and left hemiplegia and underwent gross total resection of the tumor. Given the diagnosis of glioblastoma, he was treated with radiotherapy combined with concurrent and adjuvant temozolomide. Six months after tumor resection, the patient presented with severe back pain, and was diagnosed as metastatic glioblastoma on the first lumbar vertebrae. Posterior decompression with fixation and postoperative radiotherapy were conducted. He went on to receive temozolomide and bevacizumab. However, at 3 months after the diagnosis of lumbar metastasis, further disease progression was noted, and his care was transitioned to best supportive care. Comparison on copy number status between primary and metastatic lesions on methylation array analysis revealed more enhanced chromosomal instability including 7p loss, 7q gain and 8 gain in the metastatic lesion. Conclusion Based upon the literature review and our case, younger age of initial presentation, multiple surgical interventions, and long overall survival seem to be the risk factors of vertebral metastasis. As the prognosis of glioblastoma improves over time, its vertebral metastasis is seemingly more common. Therefore, extradural metastasis should be kept in mind in the treatment of glioblastoma. Further, detailed genomic analysis on multiple paired specimens is mandated to elucidate the molecular mechanisms of vertebral metastasis.
Collapse
Affiliation(s)
- Ako Matsuhashi
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Shota Tanaka
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hirokazu Takami
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masashi Nomura
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Masako Ikemura
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Yusuke Shinoda
- Department of Rehabilitation Medicine, Saitama Medical University Hospital, Saitama, Japan
| | - Keisuke Yamada
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yu Sakai
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuaki Karasawa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Nobuhito Saito
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Essibayi MA, Abdallah A, Özek E, Coban G. Multiple recurrences of unknown primary tumor in a meningioma: A case report. Neuroradiol J 2022; 35:763-767. [PMID: 35488191 PMCID: PMC9626840 DOI: 10.1177/19714009221096836] [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] [Indexed: 11/15/2022] Open
Abstract
Metastasis of a systemic tumor into a primary brain tumor has been rarely reported in the literature. These metastases could be seen mostly in meningiomas and in less frequently in the other intracranial tumors. Carcinoma of an unknown primary site (CUP) metastasizing into an intracranial meningioma is not a common occasion. According to the best of our knowledge, in this report, we present the first case with multiple recurrent CUP, which metastasized to intracranial meningioma, reported in the literature. The whole body was investigated with FDG PET/CT and biomarkers of the most common carcinomas for primary cancer. However, these tests showed no primary affected region. Despite all adjuvant therapies, the tumor had multiple recurrences. Such cases are still a challenge to offer optimal management.
Collapse
Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
- Equal contribution
| | - Anas Abdallah
- Osmaniye State Hospital, D400 Karayolu Üzeri Akyar Mevkii,
Osmaniye
- Equal contribution
| | - Erdinç Özek
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ganime Coban
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
9
|
Luo M, Yang J, Sun J, Wang F, Chai X. Primary gliosarcoma with widespread extracranial metastases—spatiotemporal morphological variation. Chin Neurosurg J 2022; 8:20. [PMID: 35932030 PMCID: PMC9354287 DOI: 10.1186/s41016-022-00285-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 06/08/2022] [Indexed: 12/25/2022] Open
Abstract
Abstract
Background
We summarize 5 cases of primary gliosarcoma with widespread extracranial metastases including our case. The glial components are eliminated due to the needs of the living environment in the process of parasitism and survival of brain glioma-sarcoma cells in lung metastasis.
Methods
A PubMed search using the keywords “gliosarcoma” and “extracranial metastases” was performed followed by a review of cited literature. Our case was a 50-year-old female presented with headache and dizziness. MRI examination showed that there was a cystic solid tumor in the right temporal lobe. The tumor was removed totally. Seven months after the operation, the patient suffered recurrent intermittent headache. The resection for the recurrent tumor was performed. Postoperative pathology confirmed the recurrent gliosarcoma. A needle biopsy was performed for the nodular on the right lung. The lung tumor pathology suggested a sarcoma structure.
Results
There was a female patient in five cases. The age range is 47 to 69 years old. The tumor recurred within a year. A combination of treatment modalities may extend survival; however, the prognosis remains poor.
Conclusion
Primary gliosarcoma with extracranial metastases is extremely rare. Some findings uncovered an unexpected spatiotemporal morphological variation in the different foci of the same malignancy.
Collapse
|
10
|
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.
Collapse
|
11
|
Coca-Pelaz A, Bishop JA, Zidar N, Agaimy A, Gebrim EMMS, Mondin V, Cohen O, Strojan P, Rinaldo A, Shaha AR, de Bree R, Hamoir M, Mäkitie AA, Kowalski LP, Saba NF, Ferlito A. Cervical Lymph Node Metastases from Central Nervous System Tumors: A Systematic Review. Cancer Manag Res 2022; 14:1099-1111. [PMID: 35300060 PMCID: PMC8921675 DOI: 10.2147/cmar.s348102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Lymph node metastasis (LNM) from primary tumors of the central nervous system (CNS) is an infrequent condition, and classically it was thought that CNS tumors could not spread via the lymphatic route. Recent discoveries about this route of dissemination make its knowledge necessary for surgeons and pathologists to avoid delays in diagnosis and unnecessary treatments. The aim of this paper is to review the literature and to discuss the relevant pathogenetic mechanism and the cytologic features along with recommendations for surgical treatment of these cervical LNM. Materials and Methods Using PRISMA guidelines, we conducted a systematic review of the literature published from 1944 to 2021, updating the comprehensive review published in 2010 by our group. Results Our review includes data of 143 articles obtaining 174 patients with LNM from a primary CNS tumor. The mean age of the patients was 31.9 years (range, 0.1–87) and there were 61 females (35.1%) and 103 males (59.2%), and in 10 cases (5.7%) the gender was not specified. The more frequent sites of distant metastasis were bones (23%), lungs (11.5%) and non-cervical lymph nodes (11%). Conclusion Cervical LNM from CNS tumors is infrequent. Pathologic diagnosis can be obtained by fine-needle aspiration cytology in most cases, giving surgeons the option to plan the appropriate surgical treatment. Given the poor prognosis of these cases, the most conservative possible cervical dissection is usually the treatment of choice.
Collapse
Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo (Asturias), Spain
- Correspondence: Andrés Coca-Pelaz, Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Avenida de Roma s/n, Oviedo (Asturias), 33011, Spain, Email
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Abbas Agaimy
- Institute of Pathology, Friedrich Alexander University Erlangen-Nürnberg, University Hospital, Erlangen, Germany
| | - Eloisa Maria Mello Santiago Gebrim
- Otorhinolaryngology Department, National Institute of Rehabilitation, Mexico City, Mexico
- Radiology Department, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Vanni Mondin
- ENT Clinic, Policlinico Città di Udine, Udine, Italy
| | - Oded Cohen
- ARM - Center for Otolaryngology - Head and Neck Surgery and Oncology, Assuta Medical Center, Tel Aviv, Affiliated with Ben Gurion University, Beer Sheva, Israel
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The NetherlAnds
| | - Marc Hamoir
- Department of Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Brussels, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center and Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
12
|
Extraneural Metastases of Diffuse Midline Glioma, H3 K27M-Mutant at Diagnosis: Case Report, Review of the Literature, and Identifying Targetable Alterations. J Pediatr Hematol Oncol 2022; 44:e597-e604. [PMID: 33974582 DOI: 10.1097/mph.0000000000002189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Extraneural metastases are rare in pediatric high-grade gliomas and little is known about the genomic profiles of tumors that disseminate beyond the central nervous system. We describe a pediatric patient with H3 K27M-mutant diffuse midline glioma of the brain and spine with biopsy-confirmed osseous metastases present at diagnosis and suspected metastatic parenchymal pulmonary disease. Several potentially clinically and/or therapeutically relevant genomic alterations were identified, including H3F3A and TP53 mutations as well as MET, CDK6, EMSY, and PIK3CG amplifications. Sequencing is critical to improve our understanding of the molecular drivers of distant metastases and discover therapeutic targets that penetrate all disease sites.
Collapse
|
13
|
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.
Collapse
Affiliation(s)
| | | | | | | | | | - Stephen J Bagley
- Hematology Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | |
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Noch EK, Sait SF, Farooq S, Trippett TM, Miller AM. A case series of extraneural metastatic glioblastoma at Memorial Sloan Kettering Cancer Center. Neurooncol Pract 2021; 8:325-336. [PMID: 34055380 DOI: 10.1093/nop/npaa083] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Extraneural metastasis of glioma is a rare event, often occurring in patients with advanced disease. Genomic alterations associated with extraneural glioma metastasis remain incompletely understood. Methods Ten patients at Memorial Sloan Kettering Cancer Center diagnosed with extraneural metastases of glioblastoma (9 patients) and gliosarcoma (1 patient) from 2003 to 2018 were included in our analysis. Patient characteristics, clinical course, and genomic alterations were evaluated. Results Patient age at diagnosis ranged from 14 to 73, with 7 men and 3 women in this group. The median overall survival from initial diagnosis and from diagnosis of extraneural metastasis was 19.6 months (range 11.2 to 57.5 months) and 5 months (range 1 to 16.1 months), respectively. The most common site of extraneural metastasis was bone, with other sites being lymph nodes, dura, liver, lung, and soft tissues. All patients received surgical resection and radiation, and 9 patients received temozolomide, with subsequent chemotherapy appropriate for individual cases. 1 patient had an Ommaya and then ventriculoperitoneal shunt placed, and 1 patient underwent craniectomy for cerebral edema associated with a brain abscess at the initial site of resection. Genomic analysis of primary tumors and metastatic sites revealed shared and private mutations with a preponderance of tumor suppressor gene alterations, illustrating clonal evolution in extraneural metastases. Conclusions Several risk factors emerged for extraneural metastasis of glioblastoma and gliosarcoma, including sarcomatous dedifferentiation, disruption of normal anatomic barriers during surgical resection, and tumor suppressor gene alterations. Next steps with this work include validation of these genomic markers of glioblastoma metastases in larger patient populations and the development of preclinical models. This work will lead to a better understanding of the molecular mechanisms of metastasis to develop targeted treatments for these patients.
Collapse
Affiliation(s)
- Evan K Noch
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sameer F Sait
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shama Farooq
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Tanya M Trippett
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexandra M Miller
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
16
|
Mohiuddin S, Maraka S, Usman Baig M, Gupta S, Muzzafar T, Valyi-Nagy T, Lindsay H, Moody K, Razvi S, Paulino A, Slavin K, Gondi V, McCutcheon I, Zaky W, Khatua S. Case series of diffuse extraneural metastasis in H3F3A mutant high-grade gliomas: Clinical, molecular phenotype and literature review. J Clin Neurosci 2021; 89:405-411. [PMID: 34053821 DOI: 10.1016/j.jocn.2021.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
H3K27M and H3.3G34R/V mutations have been identified in pediatric high-grade gliomas (pHGG), though extraneural metastases are rarely reported and poorly characterized. Three pHGG patients from two institutions were identified with extraneural metastasis, harboring histone mutations. Their clinical, imaging and molecular characteristics are reported here. A 17-year old female presented with supratentorial H3.3G34R-mutant glioma with metastatic osseous lesions in the spine, pelvis, bone marrow, pleural effusion and soft tissue of pelvis. Bone marrow biopsy and soft tissue of pelvis biopsy showed neoplastic cells positive for P53. A 20-year old female was diagnosed with H3F3A H3K27M-mutant thalamic glioma. She developed diffuse sclerotic osseous lesions. Biopsy of an osseous lesion was non-diagnostic. A 17-year old female presented with a H3F3A H3K27M-mutant diffuse midline glioma with diffuse spinal cord metastasis. She further developed multifocal chest lymphadenopathy, pleural effusions, and a soft tissue mass in the abdominal wall. The latter was positive for H3K27M mutation. We present the first case series of pHGG with H3F3A mutation and diffuse extraneural dissemination, describing their clinical and molecular profile.
Collapse
Affiliation(s)
- Sana Mohiuddin
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stefania Maraka
- Department of Neurology and Rehabilitation, University of Illinois at Chicago, Chicago, IL, USA; Department of Neuro-oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Muhammad Usman Baig
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sumit Gupta
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tariq Muzzafar
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tibor Valyi-Nagy
- Department of Pathology, University of Illinois at Chicago, Chicago, IL, USA
| | - Holly Lindsay
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Karen Moody
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shehla Razvi
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold Paulino
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Konstantin Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Vinai Gondi
- Northwestern Medicine Chicago Proton Center, Warrenville, IL, USA
| | - Ian McCutcheon
- Department of Neurosurgery, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Wafik Zaky
- Department of Pediatrics Patient Care, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Soumen Khatua
- Department of Hematology-Oncology, Mayo Clinic, Rochester, MN.
| |
Collapse
|
17
|
Briones-Claudett KH, Briones-Claudett MH, Villacrés Garcia F, Ortega Almeida C, Escudero-Requena A, Benítez Solís J, Briones Zamora KH, Briones Márquez DC, Grunauer M. Early Pulmonary Metastasis After a Surgical Resection of Glioblastoma Multiforme. A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922976. [PMID: 32794473 PMCID: PMC7414824 DOI: 10.12659/ajcr.922976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Male, 66-year-old Final Diagnosis: Glioblastoma multiforme • pulmonary metastases Symptoms: Hemiplegia and aphasia • nausea • vomiting Medication:— Clinical Procedure: Bronchoscopy • craniotomy Specialty: Critical Care Medicine • Pulmonology
Collapse
Affiliation(s)
- Killen H Briones-Claudett
- Faculty of Medical Sciences, University of Guayaquil, Guayaquil, Ecuador.,Physiology and Respiratory-Center Briones-Claudett, Guayaquil, Ecuador.,Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | - Mónica H Briones-Claudett
- Physiology and Respiratory-Center Briones-Claudett, Guayaquil, Ecuador.,Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | | | - Camilo Ortega Almeida
- Intensive Care Unit, Ecuadorian Institute of Social Security (IESS), Babahoyo, Ecuador
| | | | | | - Killen H Briones Zamora
- Faculty of Medical Sciences, Holy Spirit University (Universidad Espíritu Santo), Samborondón, Ecuador
| | | | - Michelle Grunauer
- School of Medicine, San Francisco University of Quito (San Francisco de Quito University), Quito, Ecuador.,Pediatric Critical Care Unit, Hospital of the Valley, Quito, Ecuador
| |
Collapse
|
18
|
Li ZG, Zheng MY, Zhao Q, Liu K, Du JX, Zhang SW. Solitary vertebral metastatic glioblastoma in the absence of primary brain tumor relapse: a case report and literature review. BMC Med Imaging 2020; 20:89. [PMID: 32736607 PMCID: PMC7395336 DOI: 10.1186/s12880-020-00488-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 07/22/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Metastatic glioblastoma presenting as a solitary osteolytic cervical vertebral mass without primary brain tumor relapse is extremely rare with only 1 reported case in the literature. Because of its rarity, it can be easily overlooked and misdiagnosed, posing a diagnostic dilemma. CASE PRESENTATION A 51-year-old man with right temporal glioblastoma was initially treated by tumor resection, radiotherapy and chemotherapy. Eighteen months after surgery, he was readmitted with complaints of neck pain for 2 weeks. Follow-up magnetic resonance imaging (MRI) and fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) revealed a solitary FDG-avid osteolytic lesion in the 4th cervical vertebral body without other abnormal FDG-uptake in the body and in the absence of local recurrence at the resection cavity. Because of the sudden worsening situation and intractable neck pain, the patient underwent tumor resection. Postoperatively, the pain was obviously reduced and the situation was improved. Interestingly, the immunohistochemical findings of glial fibrillary acidic protein (GFAP) indicated the characteristic of metastatic glioblastoma, despite that the histopathological findings of Hematoxylin & Eosin (H&E) staining was suspicious of osteoclastoma. According to the clinical history, imaging findings, pathological and immunohistochemical results, a final diagnosis of solitary vertebral metastasis from glioblastoma without central nervous system (CNS) relapse was confirmed. Then, the patient received radiotherapy on spine and adjuvant chemotherapy with temozolomide. However, he died suddenly 2 months after the tumor resection, nearly 21 months after the initial diagnosis. CONCLUSION We emphasize that metastatic glioblastoma should be considered in the differential diagnosis of a solitary FDG-avid osteolytic vertebral mass on PET/CT. And the diagnosis of extracranial metastasis (ECM) from glioblastoma can be achieved through clinical history, imaging findings, pathological examination, and immunohistochemical staining with GFAP.
Collapse
Affiliation(s)
- Zu-Gui Li
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Department of Pathology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Min-Ying Zheng
- Department of Pathology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Qi Zhao
- Department of Pathology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Kai Liu
- Department of Pathology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Jia-Xing Du
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Department of Pathology, Tianjin Union Medical Center, Tianjin, 300121, China
| | - Shi-Wu Zhang
- Department of Pathology, Tianjin Union Medical Center, Tianjin, 300121, China. .,Nankai University School of Medicine, Nankai University, Tianjin, 300070, China.
| |
Collapse
|
19
|
Guo G, Wang S, Hao Y, Ren Y, Wu Y, Zhang J, Liu D. STAT1 is a modulator of the expression of frequently rearranged in advanced T-cell lymphomas 1 expression in U251 cells. Oncol Lett 2020; 20:248-256. [PMID: 32565951 PMCID: PMC7285825 DOI: 10.3892/ol.2020.11555] [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] [Received: 04/29/2019] [Accepted: 01/08/2020] [Indexed: 11/08/2022] Open
Abstract
Aberrant expression of frequently rearranged in advanced T-cell lymphomas 1 (FRAT1) contributes to poor prognosis in a number of carcinomas. However, its role in glioma remains controversial. In the present study, gene expression profiling was performed using Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology (GO) functional enrichment and ingenuity pathway analysis (IPA) to evaluate the differential expression of genes and proteins in FRAT1 knockdown U251 glioma cells in comparison with the control. Western blot analysis was conducted to assess the expression levels of FRAT1 and STAT1. A total of 895 downregulated genes were identified in FRAT1-silenced U251 cells. The most enriched processes determined by GO and KEGG analysis of the 895 differentially expressed genes were associated with proliferation, migration and invasion. According to IPA, significant canonical pathways, including the interferon, hepatic fibrosis and Wnt/β-catenin signaling pathways, were identified to be the major enriched pathways. The elevated expression of STAT1 in U251 cells was validated. These results highlighted the regulatory role of FRAT1 in glioma cells with upregulated STAT1 expression.
Collapse
Affiliation(s)
- Geng Guo
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Shule Wang
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Yining Hao
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Yeqing Ren
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Yongqiang Wu
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Jianping Zhang
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| | - Dong Liu
- Department of Neurosurgery, The First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030000, P.R. China
| |
Collapse
|
20
|
Georgescu MM, Olar A. Genetic and histologic spatiotemporal evolution of recurrent, multifocal, multicentric and metastatic glioblastoma. Acta Neuropathol Commun 2020; 8:10. [PMID: 32014051 PMCID: PMC6998196 DOI: 10.1186/s40478-020-0889-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma is the most frequent and aggressive primary brain tumor, characterized by extensive brain invasion and rarely, systemic metastases. The pathogenesis of metastatic glioblastoma is largely unknown. We present the first integrated clinical/histologic/genetic analysis of 5 distinct brain and lung foci from a unique case of recurrent, multifocal, multicentric and metastatic glioblastoma. The initial right frontotemporal gliosarcoma received standard surgical/chemoradiation therapy and recurred 1.5 years later, co-occurring with three additional masses localized to the ipsilateral temporal lobe, cerebellum and lung. Synchronous metastatic lung carcinoma was suspected in this long-term smoker patient with family history of cancer. However, glioblastoma was confirmed in all tumors, although with different morphologic patterns, including ependymomatous and epithelioid. Genomic profiling revealed a germline FANCD2 variant of unknown significance, and a 4-gene somatic mutation signature shared by all tumors, consisting of TERT promoter and PTEN, RB1 and TP53 tumor suppressor mutations. Additional GRIN2A and ATM heterozygous mutations were selected in the cerebellar and lung foci, but were variably present in the supratentorial foci, indicating reduced post-therapeutic genetic evolution in brain foci despite morphologic variability. Significant genetic drift characterized the lung metastasis, likely explaining the known resistance of circulating glioblastoma cells to systemic seeding. MET overexpression was detected in the initial gliosarcoma and lung metastasis, possibly contributing to invasiveness. This comprehensive analysis sheds light on the temporospatial evolution of glioblastoma and underscores the importance of genetic testing for diagnosis and personalized therapy.
Collapse
|
21
|
Umphlett M, Shea S, Tome-Garcia J, Zhang Y, Hormigo A, Fowkes M, Tsankova NM, Yong RL. Widely metastatic glioblastoma with BRCA1 and ARID1A mutations: a case report. BMC Cancer 2020; 20:47. [PMID: 31959133 PMCID: PMC6971940 DOI: 10.1186/s12885-020-6540-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/13/2020] [Indexed: 01/08/2023] Open
Abstract
Background Glioblastoma (GBM) is a highly malignant brain neoplasm with poor survival. Despite its aggressive nature, metastatic spread of GBM is identified only rarely. While the molecular alterations associated with GBM and its subtypes are well-described, there remains a gap in understanding which alterations may predispose towards metastasis. In this report, we present a case of GBM with multi-organ metastases and discuss its genomic alterations. Case presentation A 74-year-old woman was diagnosed with left occipital glioblastoma (IDH-wildtype, MGMT-unmethylated), for which she underwent resection, standard chemoradiation, and then stereotactic radiosurgery (SRS) for local recurrence. One month after SRS, work-up for a pathologic hip fracture revealed a left breast mass, lytic lesions involving pelvic bones, and multiple pulmonary and hepatic lesions. Biopsies of the breast and bone lesions both demonstrated metastatic IDH-wildtype GBM. For worsening neurologic symptoms, the patient underwent debulking of a large right temporal lobe recurrence and expired shortly thereafter. Autopsy confirmed metastatic GBM in multiple systemic sites, including bilateral lungs, heart, liver, thyroid, left breast, small bowel, omentum, peritoneal surfaces, visceral surfaces, left pelvic bone, and hilar lymph nodes. Targeted sequencing was performed on tissue samples obtained pre- and postmortem, as well as on cell cultures and an orthotopic mouse xenograft derived from premortem surgical specimens. A BRCA1 mutation (p.I571T) was the only variant found in common among the primary, recurrence, and metastatic specimens, suggesting its likely status as an early driver mutation. Multiple subclonal ARID1A mutations, which promote genomic instability through impairment of DNA mismatch repair, were identified only in the recurrence. Mutational spectrum analysis demonstrated a high percentage of C:G to T:A transitions in the post-treatment samples but not in the primary tumor. Conclusion This case report examines a rare case of widely metastatic IDH-wildtype GBM with a clonal somatic mutation in BRCA1. Post-treatment recurrent tumor in the brain and in multiple systemic organs exhibited evidence of acquired DNA mismatch repair deficiency, which may be explained by functional loss of ARID1A. We identify a potential role for immune checkpoint and PARP inhibitors in the treatment of metastatic GBM.
Collapse
Affiliation(s)
- Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stephanie Shea
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jessica Tome-Garcia
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yizhou Zhang
- Departments of Neurosurgery and Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Adilia Hormigo
- Department of Neurology, Medicine (Division Hem-Onc), Neurosurgery and the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nadejda M Tsankova
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raymund L Yong
- Departments of Neurosurgery and Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| |
Collapse
|
22
|
Swinnen J, Gelin G, Fransis S, Vandevenne J, Van Cauter S. Glioblastoma with extracranial parotid, lymph node, and pulmonary metastases: a case report. Radiol Case Rep 2019; 14:1334-1347. [PMID: 31516649 PMCID: PMC6732724 DOI: 10.1016/j.radcr.2019.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 11/16/2022] Open
Abstract
We present a rare case of an isocitrate dehydrogenase-wildtype glioblastoma with histologically proven parotid, cervical lymph node, and lung metastases. While recent therapy advances are likely to increase glioblastoma mid- and long-term survival, this will also increase the time window for extraneural glioblastoma spread. Radiologists should be aware of this risk, so they can accurately detect and interpret metastatic glioblastoma disease.
Collapse
Affiliation(s)
- Jeroen Swinnen
- Department of Radiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Geert Gelin
- Department of Radiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Sabine Fransis
- Department of Pathology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Jan Vandevenne
- Department of Radiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,Faculty of Medicine, University of Hasselt, Agoralaan gebouw D, 3590 Diepenbeek, Belgium
| | - Sofie Van Cauter
- Department of Radiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,Department of Radiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| |
Collapse
|
23
|
Extraneural Metastasis of Primary Glioma Occurring in a Setting of Occupational Ionizing Radiation Exposure. Case Rep Neurol Med 2019; 2019:1748739. [PMID: 31312534 PMCID: PMC6595336 DOI: 10.1155/2019/1748739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022] Open
Abstract
Malignant gliomas account for 60% of all primary brain tumors in adults. Glioblastoma Multiforme (GBM) is the most common primary glial tumor with a dismal prognosis and a median survival of approximately 14 months. Extra-neural metastases from primary brain tumors are unusual with an incidence rate of less than 2%. This has been attributed to factors such as short survival, lack of true lymphatics in the CNS, and physical barriers provided by the dura, extracellular matrix, and basement membrane. Although most GBMs occur sporadically, there is a known association with therapeutic radiation exposure and with work in nuclear disaster cleanup. To our knowledge, no case of GBM with metastasis occurring in a patient with occupational radiation exposure currently exists in the literature. In this article, we present a case of GBM with lung metastasis occurring in a 51-year-old Caucasian male, whose history is significant for occupational exposure to ionizing radiation, and review the literature on GBM risk factors and potential mechanisms of metastasis.
Collapse
|
24
|
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.
Collapse
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.
| |
Collapse
|
25
|
Piccirilli M, Brunetto GMF, Rocchi G, Giangaspero F, Salvati M. Extra Central Nervous System Metastases from Cerebral Glioblastoma Multiforme in Elderly Patients. Clinico-Pathological Remarks on our Series of Seven Cases and Critical Review of the Literature. TUMORI JOURNAL 2018; 94:40-51. [DOI: 10.1177/030089160809400109] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The aim of the study was to evaluate the treatment of the extracranial metastases from glioblastoma multiforme in the elderly, discussing their uncommon occurrence and their pathogenesis. Methods The authors report seven cases of elderly patients (mean age, 69 years), with an initial diagnosis of cerebral glioblastoma multiforme, treated by a grossly total surgical removal and followed by adjuvant radiotherapy (64 Gy in 6 weeks, using Linac) and adjuvant chemotherapy (temozolomide both concomitant and sequential to radiotherapy). Results All patients presented a postoperative course characterized by good functional and clinical conditions (Karnofsky performance scale ≥70), which remained unchanged for a mean period of about 21 months (range, 16–23), with no neuroradiological signs of lesion regrowth. After this interval, new clinical signs occurred, and their clinical and radiological investigation showed metastatic repetitions in different sites: lung, liver, humerus and lymph nodes. All the metastases were surgically treated, but regrowth of the brain tumor and progression to deep important neural structures caused the patients’ exitus after a mean interval of about 10 months (range, 8–12) from the diagnosis of metastasis. Conclusions We found 128 cases of extra CNS metastases in the English literature. The main features of the patients of the previous reports and of those of the present series were analyzed. The main modalities of glioblastoma multiforme spread, the few theories about the rarity of metastasis, and the probable biological, histological and immunogenetic mechanisms involved in the pathogenesis are described. Although several studies have reported a poor outcome in elderly patients, they affirm that the treatment of those with a Karnofsky performance status >60 should be just as aggressive as in younger patients. This allows them to obtain a longer survival time and to also treat metastases, which are uncommon particularly in the elderly.
Collapse
Affiliation(s)
- Manolo Piccirilli
- Department of Neurological Sciences-Neurosurgery, University of Rome “Sapienza”, Rome
| | | | - Giovanni Rocchi
- Department of Neurological Sciences-Neurosurgery, University of Rome “Sapienza”, Rome
| | - Felice Giangaspero
- Department of Experimental Medicine and Pathology, University of Rome “Sapienza”, Rome
| | | |
Collapse
|
26
|
Xu M, Wang Y, Xu J, Yao Y, Yu WX, Zhong P. Extensive Therapies for Extraneural Metastases from Glioblastoma, as Confirmed with the OncoScan Assay. World Neurosurg 2016; 90:698.e7-698.e11. [DOI: 10.1016/j.wneu.2016.01.074] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 11/28/2022]
|
27
|
Presentation of Two Cases with Early Extracranial Metastases from Glioblastoma and Review of the Literature. Case Rep Oncol Med 2016; 2016:8190950. [PMID: 27247816 PMCID: PMC4876220 DOI: 10.1155/2016/8190950] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 11/29/2022] Open
Abstract
Extracranial metastases from glioblastoma are rare. We report two patients with extracranial metastases from glioblastoma. Case 1 concerns a 59-year-old woman with multiple metastases that spread early in the course of disease. What makes this case unusual is that the tumor had grown into the falx close to the straight sinus and this might be an explanation to the early and extensive metastases. Case 2 presents a 60-year-old man with liver metastasis found at autopsy, and, in this case, it is more difficult to find an explanation. This patient had two spontaneous intracerebral bleeding incidents and extensive bleeding during acute surgery with tumor removal, which might have induced extracranial seeding. The cases presented might have hematogenous spreading in common as an explanation to extracranial metastases from GBM.
Collapse
|
28
|
Biller A, Badde S, Nagel A, Neumann JO, Wick W, Hertenstein A, Bendszus M, Sahm F, Benkhedah N, Kleesiek J. Improved Brain Tumor Classification by Sodium MR Imaging: Prediction of IDH Mutation Status and Tumor Progression. AJNR Am J Neuroradiol 2015; 37:66-73. [PMID: 26494691 DOI: 10.3174/ajnr.a4493] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/09/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging in neuro-oncology is challenging due to inherent ambiguities in proton signal behavior. Sodium-MR imaging may substantially contribute to the characterization of tumors because it reflects the functional status of the sodium-potassium pump and sodium channels. MATERIALS AND METHODS Sodium-MR imaging data of patients with treatment-naïve glioma WHO grades I-IV (n = 34; mean age, 51.29 ± 17.77 years) were acquired by using a 7T MR system. For acquisition of sodium-MR images, we applied density-adapted 3D radial projection reconstruction pulse sequences. Proton-MR imaging data were acquired by using a 3T whole-body system. RESULTS We demonstrated that the initial sodium signal of a treatment-naïve brain tumor is a significant predictor of isocitrate dehydrogenase (IDH) mutation status (P < .001). Moreover, independent of this correlation, the Cox proportional hazards model confirmed the sodium signal of treatment-naïve brain tumors as a predictor of progression (P = .003). Compared with the molecular signature of IDH mutation status, information criteria of model comparison revealed that the sodium signal is even superior to IDH in progression prediction. In addition, sodium-MR imaging provides a new approach to noninvasive tumor classification. The sodium signal of contrast-enhancing tumor portions facilitates differentiation among most glioma types (P < .001). CONCLUSIONS The information of sodium-MR imaging may help to classify neoplasias at an early stage, to reduce invasive tissue characterization such as stereotactic biopsy specimens, and overall to promote improved and individualized patient management in neuro-oncology by novel imaging signatures of brain tumors.
Collapse
Affiliation(s)
- A Biller
- From the Departments of Neuroradiology (A.B., M.B., J.K.) Departments of Radiology (A.B., J.K.)
| | - S Badde
- Department of Biological Psychology and Neuropsychology (S.B.), University of Hamburg, Hamburg, Germany
| | - A Nagel
- Medical Physics in Radiology (A.N., N.B.), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - W Wick
- Neuro-Oncology (W.W., A.H.)
| | | | - M Bendszus
- From the Departments of Neuroradiology (A.B., M.B., J.K.)
| | | | - N Benkhedah
- Medical Physics in Radiology (A.N., N.B.), German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - J Kleesiek
- From the Departments of Neuroradiology (A.B., M.B., J.K.) Multidimensional Image Processing Group (J.K.), HCI/IWR, University of Heidelberg, Heidelberg, Germany Departments of Radiology (A.B., J.K.)
| |
Collapse
|
29
|
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.
Collapse
|
30
|
Ray A, Manjila S, Hdeib AM, Radhakrishnan A, Nock CJ, Cohen ML, Sloan AE. Extracranial metastasis of gliobastoma: Three illustrative cases and current review of the molecular pathology and management strategies. Mol Clin Oncol 2015; 3:479-486. [PMID: 26137254 DOI: 10.3892/mco.2015.494] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/08/2015] [Indexed: 12/19/2022] Open
Abstract
Glioblastoma (GBM) is the most common and the most malignant primary brain tumor in adults, accounting for ~12-15% of all intracranial neoplasms. Despite advances in surgical, medical and radiation therapies, the mortality of GBM remains high, with a median survival ranging between 40 and 70 weeks. Similar to other primary brain tumors, the extracranial metastasis of GBM is extremely rare, occurring in <2% of patients. To demonstrate the clinical characteristics of this rare tumor, we herein present three cases of extracranial GBM metastasis: One to the lungs, which represents the longest reported survival of lung metastases from GBM to date; the second to the soft tissue of the posterior neck; and the third to the lumbar intradural space. Unlike tumors elsewhere, there are unique barriers in the brain that prevent the hematogenous and lymphatic spread of intracranial tumors, such as the dura mater and the thickened basement membrane of the blood vessels. In addition, central nervous system tumor cells lack extracellular matrix proteins required to invade surrounding connective tissue, a prerequisite for tumor dissemination. In this study, we aimed to investigate the different possible mechanisms underlying the extracranial metastasis of GBM and determine the biomolecular and genetic characteristics differentiating GBMs that metastasize from those that do not. We also reviewed the role of systemic chemotherapy and bevacizumab in the treatment of disseminated GBMs. Early identification and differentiation of these tumors may enable patients to benefit from surgical resection, radiation and combination chemotherapy prior to developing other comorbidities from metastatic disease, which may translate into prolonged survival with an acceptable quality of life.
Collapse
Affiliation(s)
- Abhishek Ray
- Brain Tumor and Neuro-Oncology Center and Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Sunil Manjila
- Brain Tumor and Neuro-Oncology Center and Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Alia M Hdeib
- Brain Tumor and Neuro-Oncology Center and Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Archana Radhakrishnan
- Department of Oncology, University Hospitals Case Medical Center, Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH 44106, USA
| | - Charles J Nock
- Department of Oncology, University Hospitals Case Medical Center, Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH 44106, USA
| | - Mark L Cohen
- Department of Pathology, University Hospitals Case Medical Center, Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH 44106, USA
| | - Andrew E Sloan
- Brain Tumor and Neuro-Oncology Center and Department of Neurological Surgery, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA ; Department of Pathology, University Hospitals Case Medical Center, Seidman Cancer Center and Case Comprehensive Cancer Center, Cleveland, OH 44106, USA
| |
Collapse
|
31
|
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]
|
32
|
Kalokhe G, Grimm SA, Chandler JP, Helenowski I, Rademaker A, Raizer JJ. Metastatic glioblastoma: case presentations and a review of the literature. J Neurooncol 2011; 107:21-7. [PMID: 21964740 DOI: 10.1007/s11060-011-0731-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/19/2011] [Indexed: 12/31/2022]
Abstract
Extracranial metastases from glioblastoma (GBM) are uncommon with an estimated incidence of less than 2%. We report two cases of metastatic GBM seen within an 8-week period followed by a literature review. We attempted to identify common factors or a causative mechanism. Factors that predominated among the reviewed cases included male gender, tumor location, and younger age. Causative mechanisms were not apparent. While metastatic disease remains rare, it might be occurring with increasing frequency. This trend might be due to increased diagnosis, better imaging, a more extensive physician workup, or an increase in survival. Metastatic GBM can present and progress quite rapidly, and repeat evaluations of persistent or worsening complaints among GBM patients are warranted. Early diagnosis of metastatic disease spread can help to expedite alleviation of patients' discomfort, in an already aggressive disease process.
Collapse
Affiliation(s)
- Gauri Kalokhe
- Department of Neurology, Northwestern University, Feinberg School of Medicine, 710 North Lake Shore Drive, Abbott Hall, Room 1123, Chicago, IL 60611, USA
| | | | | | | | | | | |
Collapse
|
33
|
Fomchenko EI, Dougherty JD, Helmy KY, Katz AM, Pietras A, Brennan C, Huse JT, Milosevic A, Holland EC. Recruited cells can become transformed and overtake PDGF-induced murine gliomas in vivo during tumor progression. PLoS One 2011; 6:e20605. [PMID: 21754979 PMCID: PMC3130733 DOI: 10.1371/journal.pone.0020605] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 05/05/2011] [Indexed: 11/19/2022] Open
Abstract
Background Gliomas are thought to form by clonal expansion from a single cell-of-origin, and progression-associated mutations to occur in its progeny cells. Glioma progression is associated with elevated growth factor signaling and loss of function of tumor suppressors Ink4a, Arf and Pten. Yet, gliomas are cellularly heterogeneous; they recruit and trap normal cells during infiltration. Methodology/Principal Findings We performed lineage tracing in a retrovirally mediated, molecularly and histologically accurate mouse model of hPDGFb-driven gliomagenesis. We were able to distinguish cells in the tumor that were derived from the cell-of-origin from those that were not. Phenotypic, tumorigenic and expression analyses were performed on both populations of these cells. Here we show that during progression of hPDGFb-induced murine gliomas, tumor suppressor loss can expand the recruited cell population not derived from the cell-of-origin within glioma microenvironment to dominate regions of the tumor, with essentially no contribution from the progeny of glioma cell-of-origin. Moreover, the recruited cells can give rise to gliomas upon transplantation and passaging, acquire polysomal expression profiles and genetic aberrations typically present in glioma cells rather than normal progenitors, aid progeny cells in glioma initiation upon transplantation, and become independent of PDGFR signaling. Conclusions/Significance These results indicate that non-cell-of-origin derived cells within glioma environment in the mouse can be corrupted to become bona fide tumor, and deviate from the generally established view of gliomagenesis.
Collapse
Affiliation(s)
- Elena I. Fomchenko
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Joseph D. Dougherty
- Department of Molecular Biology, Rockefeller University, New York, New York, United States of America
| | - Karim Y. Helmy
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Amanda M. Katz
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Alexander Pietras
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Cameron Brennan
- Departments of Surgery (Neurosurgery) and Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Jason T. Huse
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Departments of Human Oncology, Pathology and Pathogenesis, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Ana Milosevic
- Department of Molecular Biology, Rockefeller University, New York, New York, United States of America
| | - Eric C. Holland
- Department of Cancer Biology and Genetics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Departments of Surgery (Neurosurgery) and Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- * E-mail:
| |
Collapse
|
34
|
Beauchesne P. Extra-neural metastases of malignant gliomas: myth or reality? Cancers (Basel) 2011; 3:461-77. [PMID: 24212625 PMCID: PMC3756372 DOI: 10.3390/cancers3010461] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 01/04/2011] [Accepted: 01/19/2011] [Indexed: 01/15/2023] Open
Abstract
Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years-despite debulking surgery, radiotherapy and cytotoxic chemotherapy-with a median survival of 9-12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases.
Collapse
Affiliation(s)
- Patrick Beauchesne
- Neuro-Oncology, CHU de NANCY, Hôpital Central, CO n°34, 54035 Nancy Cedex, France.
| |
Collapse
|
35
|
Mondin V, Ferlito A, Devaney KO, Woolgar JA, Rinaldo A. A survey of metastatic central nervous system tumors to cervical lymph nodes. Eur Arch Otorhinolaryngol 2010; 267:1657-66. [PMID: 20694730 DOI: 10.1007/s00405-010-1357-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 07/26/2010] [Indexed: 10/19/2022]
Abstract
In the realm of head and neck diseases, one particularly common clinical presentation is that of the patient with a cervical mass. In children, neck masses often prove to be developmental cysts; in adults, the recent onset of a neck mass can signal a metastasis from a head and neck squamous carcinoma. Less often, both adults and children may present with cervical masses caused by either non-Hodgkin's lymphoma or Hodgkin's disease. There are, of course, less frequently encountered differential diagnostic possibilities; one of the most uncommon of all is the possibility of metastasis from an intracranial tumor. Intracranial tumors rarely give rise to cervical node metastases. The present review examines the published experience with 128 tumors that gave rise to cervical node metastases in both adult and in pediatric patients. While it is presumed that the blood-brain barrier blocks the spread of most tumors beyond the intracranial locale, this is speculative. Although many of the cervical node metastases reported here arose after craniotomy (and, presumably, after breaching of the blood-brain barrier), some arose in the absence of any preceding surgical procedure. Cervical node metastases may arise from glial tumors (including glioblastoma multiforme, in both adult and pediatric patients) and non-glial tumors (such as medulloblastoma in pediatric patients). The history of a previous intracranial lesion is often the key to correct diagnosis, since, without prompting, neither the pathologist nor the radiologist is likely to think of a cervical node metastasis from a brain tumor when assessing a cervical mass of unknown etiology.
Collapse
Affiliation(s)
- Vanni Mondin
- Department of Surgical Sciences, ENT Clinic, University of Udine, Udine, Italy
| | | | | | | | | |
Collapse
|
36
|
Groenendijk FH, Taal W, Dubbink HJ, Haarloo CR, Kouwenhoven MC, van den Bent MJ, Kros JM, Dinjens WNM. MGMT promoter hypermethylation is a frequent, early, and consistent event in astrocytoma progression, and not correlated with TP53 mutation. J Neurooncol 2010; 101:405-17. [PMID: 20593220 PMCID: PMC3024495 DOI: 10.1007/s11060-010-0274-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 06/16/2010] [Indexed: 01/01/2023]
Abstract
Hypermethylation of the MGMT gene promoter and mutation of the TP53 tumor-suppressor gene are frequently present in diffuse astrocytomas. However, there is only anecdotal information about MGMT methylation status and TP53 mutations during progression of low-grade diffuse astrocytoma (AII) to anaplastic astrocytoma (AIII) and secondary glioblastoma (sGB). In this study biopsy specimens from 51 patients with astrocytic tumors with radiologically proved progression from low to high-grade malignancy were investigated for the presence and consistency of MGMT promoter hypermethylation and TP53 mutations. For 27 patients biopsy samples both of primary tumors and their recurrences were available. For the other 24 patients histology of either the low-grade lesion or the high-grade recurrence was available. It was found that MGMT promoter hypermethylation and TP53 mutations are both frequent and early events in the progression of astrocytomas and that their status is consistent over time. No correlation was found between MGMT methylation status and the presence of TP53 mutations. In addition, no correlation was found between MGMT promoter hypermethylation and the type of TP53 mutations. These results argue against the putative TP53 G:C>A:T transition mutations suggested to occur preferentially in MGMT hypermethylated tumors.
Collapse
Affiliation(s)
- Floris H Groenendijk
- Department of Pathology, Josephine Nefkens Institute, Be320a, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Ghulam Muhammad AKM, Candolfi M, King GD, Yagiz K, Foulad D, Mineharu Y, Kroeger KM, Treuer KA, Nichols WS, Sanderson NS, Yang J, Khayznikov M, Van Rooijen N, Lowenstein PR, Castro MG. Antiglioma immunological memory in response to conditional cytotoxic/immune-stimulatory gene therapy: humoral and cellular immunity lead to tumor regression. Clin Cancer Res 2009; 15:6113-27. [PMID: 19789315 DOI: 10.1158/1078-0432.ccr-09-1087] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Glioblastoma multiforme is a deadly primary brain cancer. Because the tumor kills due to recurrences, we tested the hypothesis that a new treatment would lead to immunological memory in a rat model of recurrent glioblastoma multiforme. EXPERIMENTAL DESIGN We developed a combined treatment using an adenovirus (Ad) expressing fms-like tyrosine kinase-3 ligand (Flt3L), which induces the infiltration of immune cells into the tumor microenvironment, and an Ad expressing herpes simplex virus-1-thymidine kinase (TK), which kills proliferating tumor cells in the presence of ganciclovir. RESULTS This treatment induced immunological memory that led to rejection of a second glioblastoma multiforme implanted in the contralateral hemisphere and of an extracranial glioblastoma multiforme implanted intradermally. Rechallenged long-term survivors exhibited anti-glioblastoma multiforme-specific T cells and displayed specific delayed-type hypersensitivity. Using depleting antibodies, we showed that rejection of the second tumor was dependent on CD8(+) T cells. Circulating anti-glioma antibodies were observed when glioblastoma multiforme cells were implanted intradermally in naïve rats or in long-term survivors. However, rats bearing intracranial glioblastoma multiforme only exhibited circulating antitumoral antibodies upon treatment with Ad-Flt3L + Ad-TK. This combined treatment induced tumor regression and release of the chromatin-binding protein high mobility group box 1 in two further intracranial glioblastoma multiforme models, that is, Fisher rats bearing intracranial 9L and F98 glioblastoma multiforme cells. CONCLUSIONS Treatment with Ad-Flt3L + Ad-TK triggered systemic anti-glioblastoma multiforme cellular and humoral immune responses, and anti-glioblastoma multiforme immunological memory. Release of the chromatin-binding protein high mobility group box 1 could be used as a noninvasive biomarker of therapeutic efficacy for glioblastoma multiforme. The robust treatment efficacy lends further support to its implementation in a phase I clinical trial.
Collapse
Affiliation(s)
- A K M Ghulam Muhammad
- Gene Therapeutics Research Institute, Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90048, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Templeton A, Hofer S, Töpfer M, Sommacal A, Fretz C, Cerny T, Gillessen S. Extraneural spread of glioblastoma--report of two cases. ACTA ACUST UNITED AC 2008; 31:192-4. [PMID: 18418021 DOI: 10.1159/000118627] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Glioblastoma, a highly aggressive tumor, accounts for the majority of all primary brain tumors in adults. Despite a destructive local growth pattern, extraneural spread of these tumors is extremely rare. CASE 1: We describe the case of a 58-year-old man with glioblastoma, in whom an epidural mass was diagnosed 5 months after initial local therapy of the brain. A positron emission tomography (PET) scan revealed multiple metastases in the lungs, in the retroperitoneum, and in the left trochanter minor region. A soft tissue swelling of the right thigh was histologically proven to be metastatic tissue from the primary glioblastoma. The patient died 11 months after initial diagnosis. CASE 2: A 47-year-old woman with recurrent glioblastoma had a long lasting complete response to chemotherapy. 2 years after initial diagnosis she presented with a pleural mass which was a metastasis of the formerly diagnosed glioblastoma. CONCLUSION Although systemic metastases in glioblastoma are rare, different organs can be involved.
Collapse
|
39
|
Didelot A, Taillandier L, Grignon Y, Vespignani H, Beauchesne P. Concomitant bone marrow metastasis of a glioblastoma multiforme revealed at the diagnosis. Acta Neurochir (Wien) 2006; 148:997-1000. [PMID: 16932995 DOI: 10.1007/s00701-006-0854-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
The rare occurrence of extra-neural metastases in patients having a tumour of the central nervous system (CNS) could mean that the symptoms of a metastatic lesion are confused with a second pathology. We recently treated a patient with a glioblastoma multiforme who was developing a pancytopaenia at the initial diagnosis. The frequent red cell and platelet transfusions were transitorily active. An extensive radiological investigation and a unilateral iliac bone marrow aspirate and biopsy were performed. Cells immunoreactive to glial fibrillary acidic protein were detected in a specimen obtained from the iliac bone. Post-mortem examination confirmed metastasis to extra-cranial bone and revealed other metastases in lung, mediastinal lymph node and spleen. Therefore, in patients with malignant glioma tumours, bone marrow metastasis, though not common, should be investigated when bone pain or cytopaenia occur.
Collapse
Affiliation(s)
- A Didelot
- Neuro-Oncologie - Neurologie, CHU de Nancy, Hôpital Central, France
| | | | | | | | | |
Collapse
|
40
|
Ng WH, Yeo TT, Kaye AH. Spinal and extracranial metastatic dissemination of malignant glioma. J Clin Neurosci 2006; 12:379-82. [PMID: 15925766 DOI: 10.1016/j.jocn.2004.11.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Accepted: 11/29/2004] [Indexed: 11/23/2022]
Abstract
Metastatic dissemination of malignant glioma is rare. Metastatic disease usually occurs within the neuraxis but extracranial spread to the liver, spleen, lung, peritoneum and lymph nodes can also occur. In most cases of metastatic disease, the patient has previously undergone a craniotomy. The prognosis is uniformly poor. The vast majority of patients do not survive beyond six months from diagnosis of metastatic spread of a primary intracranial tumour. The pathophysiology and natural history of this condition is still not fully understood, hence well-designed prospective studies are needed.
Collapse
Affiliation(s)
- Wai Hoe Ng
- Department of Neurosurgery, National Neuroscience Institute, Tan Tock Seng, Singapore.
| | | | | |
Collapse
|
41
|
Varlet P, Soni D, Miquel C, Roux FX, Meder JF, Chneiweiss H, Daumas-Duport C. New variants of malignant glioneuronal tumors: a clinicopathological study of 40 cases. Neurosurgery 2005; 55:1377-91: discussion 1391-2. [PMID: 15574220 DOI: 10.1227/01.neu.0000143033.36582.40] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 06/01/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To demonstrate that malignant glioneuronal tumors comprise a large spectrum of neoplasms, without mature ganglion-like cells, that may histologically resemble any malignant glioma (World Health Organization Grade III or IV) but have a distinct biological behavior. METHODS This series includes all tumors diagnosed as malignant glioneuronal tumors (MGNTs) in our routine practice during a 2-year period during which neurofilament protein (NFP) immunostaining was performed in any case of suspected malignant glioma with unusual clinical, radiographic, and/or histological features. Immunostaining using neuronal markers (NFP, NeuN, synaptophysin, and chromogranin) and glial fibrillary acidic protein was done on paraffin sections after antigen retrieval. The presence of NFP-positive tumor cells, including those in mitosis, was used as a hallmark diagnostic criterion of MGNT. RESULTS All tumors coexpressed glial fibrillary acidic protein and NFP. Other neuronal markers tested were inconstantly expressed. No recurrence was observed at the primary site in 36.4% of patients who underwent gross total resection. Twelve patients (33.3%) developed intra-axial and/or systemic metastases, and 4 were free of disease at 39 to 184 months. Univariate analysis revealed that gross total surgical resection was the most important prognostic factor predicting survival (44 versus 15 mo; P < 0.0001), followed by a long duration of symptoms (>1 yr; P = 0.005), young age at symptom onset (children versus adults; P = 0.045), and absence of necrosis (P = 0.02). Gross total surgical resection (P = 0.001) and a long duration of symptoms (symptoms > 1 yr; P = 0.013) proved to be independent and statistically significant prognostic factors in the multivariate analysis. CONCLUSION NFP immunostaining is required to identify MGNTs accurately. Their distinction from malignant gliomas is of paramount clinical importance, particularly for neurosurgeons, because gross total surgical resection may be curative in some cases. Finally, MGNTs may account for the long-term survival and/or occurrence of metastases demonstrated in a subset of malignant gliomas.
Collapse
Affiliation(s)
- Pascale Varlet
- Department of Pathology-Neuro-oncology, Sainte-Anne Hospital and Faculté Cochin Port-Royal, University Paris V, 75674 Paris, France
| | | | | | | | | | | | | |
Collapse
|
42
|
Dincer H, Gupta N, Biller JA, Krouwer H. Pleuropulmonary metastasis of glioblastoma multiforme: A case report and review of the literature. Chest 2004. [DOI: 10.1378/chest.126.4_meetingabstracts.962s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
43
|
Abstract
Encouragingly, some types of cancer can now be considered treatable, with patients reasonably expecting their disease to be cured. Chemotherapy and radiation therapy are effective against these cancers because they activate the so-called intrinsic apoptosis pathways within the cancer cells. Unfortunately currently available treatments are only effective against a subset of tumor types. In contrast, other cancers, such as malignant glioma, typically do not respond to currently available therapies. Some of this resistance can be attributed to these tumor cells failing to undergo apoptosis upon anticancer treatment. Recently, considerable research attention has focused on triggering apoptosis in chemotherapy- and radiation-therapy-resistant cancer cells via an alternative route-the "extrinsic" pathway, as a means of bypassing this block in apoptosis. Binding of members of the tumor necrosis factor-alpha (TNF-alpha) family of death ligands to their receptors on the cell surface triggers this pathway. Death ligands can kill some cancer cells that are resistant to the apoptotic pathway triggered by conventional anticancer treatments. Some death ligands, such as TNF-alpha and FasL, cause unacceptable toxicity to normal cells and are therefore not suitable anticancer agents. However another death ligand, TNF-related apoptosis-inducing ligand (TRAIL)/Apo-2L, and antibodies that emulate its actions, show greater promise as candidate anticancer drugs because they have negligible effects on normal cells. This review will discuss the ability of TRAIL to induce apoptosis in malignant glioma cells and the potential clinical applications of TRAIL-based agents for glioma treatment.
Collapse
Affiliation(s)
- Christine J Hawkins
- Murdoch Children's Research Institute Department of Haematology and Oncology, Royal Children's Hospital Department of Paediatrics, University of Melbourne Parkville, Victoria 3052, Australia
| |
Collapse
|
44
|
Abstract
BACKGROUND Although clinically apparent systemic metastases of gliomas are very rare, reports of gliomas developing in recipient's transplanted organs have suggested that haematogenous spread might be more common. METHODS This report describes a newly developed, sensitive real time quantitative reverse transcription polymerase chain reaction assay for the detection of mRNA encoding glial fibrillary acidic protein (GFAP). Blood from 10 patients with astrocytoma and 10 patients with glioblastoma was analysed. RESULTS No GFAP mRNA was detected. CONCLUSIONS These results suggest that even subclinical metastases are very rare and are probably restricted to distinct subsets of glioma.
Collapse
Affiliation(s)
- C Böhm
- Institute of Neuropathology, University Hospital, Domagkstr. 19, 48149 Münster, Germany
| | | | | |
Collapse
|
45
|
Abstract
Malignancy following renal transplantation is an important medical problem during the long-term follow-up. The overall incidence of malignancy at this time is 3 to 5 times higher than in the general population. The most common malignancies are lymphoproliferative disorders (early after transplantation) and skin carcinomas (late after transplantation). The type of malignancy is different in various countries and dependent on genetic and environmental factors. Another important confounder for risk of malignancy after renal transplantation is the type of immunosuppression. Previous use of cytotoxic drugs (eg, cyclophosphamide) or a history of analgesic abuse are additional risk factors. Malignancy may even be transplanted by the graft. Previous cancer treatment in a uremic patient on the transplant waiting list is of great importance in relation to waiting time and postmalignancy screening. Finally, every dialysis patient on the waiting list should undergo a regular screening program before and after renal transplantation to detect a potentially malignant tumor in an early stage. In addition to specific oncological treatment, managing a malignancy after renal transplantation should include modification of immunosuppression.
Collapse
Affiliation(s)
- Martin Zeier
- Department of Internal Medicine, Ruperto Carola University, Heidelberg, Germany.
| | | | | | | | | |
Collapse
|