1
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Heinig S, Aigner T, Bloß HG, Grabenbauer GG. Spinal and cervical nodal metastases in a patient with glioblastoma. Strahlenther Onkol 2024; 200:838-843. [PMID: 38488900 DOI: 10.1007/s00066-024-02214-w] [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: 11/13/2023] [Accepted: 02/04/2024] [Indexed: 03/17/2024]
Abstract
This article presents the rare case of a 54-year-old gentleman with primary glioblastoma developing multiple extracranial metastases 7 months after diagnosis. Initially, the patient complained of progressive headaches, confusion, and weakness of the left arm. Magnetic resonance imaging of the brain showed a right temporoparietal tumor with substantial surrounding subcortical edema and midline shift to the left. Two consecutive craniotomies resulted in complete microsurgical resection of the lesion. Histology was consistent with a World Health Organization grade IV, IDH-wildtype glioblastoma. Further treatment was standard chemoradiation including intensity-modulated radiotherapy with oral temozolomide chemotherapy. Seven months after diagnosis, the cranial lesion progressed, and the patient developed painful metastases in multiple bones and suspicious right-sided cervical lymph nodes. Immunohistochemistry and molecular signature supported the case of a metastatic glioblastoma. Further treatment was palliative radiotherapy of the spinal lesions along with symptomatic pain management. Extracranial metastasis of glioblastoma is a rare complication of which only a few cases have been reported in the literature. Little is known about the precise mechanisms of tumor dissemination and the appropriate treatment.
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Affiliation(s)
- Silvio Heinig
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany
- University of Split School of Medicine, Split, Croatia
| | - Thomas Aigner
- Department of Molecular Pathology, Coburg Cancer Center, Coburg, Germany
| | - Heinz-Georg Bloß
- Department of Neurosurgery, Coburg Cancer Center, Lichtenfels, Germany
| | - Gerhard G Grabenbauer
- Department of Radiation Oncology, Coburg Cancer Center, Coburg, Germany.
- University of Split School of Medicine, Split, Croatia.
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2
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Wang F, Dong J, Zhang J, Zhao H, Wang N, Jin J, Yan X, Gao X, Liu H, Hu S. Rapid progression of subcutaneous glioblastoma: A case report and literature review. Front Oncol 2023; 13:935944. [PMID: 36761958 PMCID: PMC9905810 DOI: 10.3389/fonc.2023.935944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023] Open
Abstract
Extra-neural spread of glioblastoma (GBM) is extremely rare. We report a case of postoperative intracranial GBM spreading to the subcutaneous tissue via the channel of craniotomy defect in a 73-year-old woman. Radiological images and histopathology indicate that the tumor microenvironment of the subcutaneous tumor is clearly different from the intracranial tumor. We also model the invasion of GBM cells through the dura-skull defect in mouse. The retrospective analysis of GBM with scalp metastases suggests that craniectomy is a direct cause of subcutaneous metastasis in patients with GBM. Imaging examinations of other sites for systemic screening is also recommended to look for metastases outside the brain when GBM invades the scalp or metastasizes to it.
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Affiliation(s)
- Fang Wang
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiawei Dong
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jiheng Zhang
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hongtao Zhao
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Wang
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jiaqi Jin
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiuwei Yan
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Gao
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Han Liu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,*Correspondence: Shaoshan Hu, ; Han Liu,
| | - Shaoshan Hu
- Cancer Center, Department of Neurosurgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China,Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China,*Correspondence: Shaoshan Hu, ; Han Liu,
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3
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Nakib CE, Hajjar R, Zerdan MB, Darwish H, Zeidan Y, Alame S, Kassouf HK, Chamseddine N, Assi HI. Glioblastoma multiforme metastasizing to the skin, a case report and literature review. Radiol Case Rep 2021; 17:171-175. [PMID: 34815821 PMCID: PMC8593264 DOI: 10.1016/j.radcr.2021.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 01/24/2023] Open
Abstract
Glioblastoma Multiforme (GBM) is the most common primary central nervous system (CNS) malignancy in adults. It is very aggressive and is notorious for its fast and local invasion of nearby brain parenchyma. Consequently, the overall survival (OS) of patients with GBM is short despite resection, radiotherapy and chemotherapy regimens. The most common sites of metastasis of GBM are the lungs and pleura, cervical lymph nodes, and bone. Metastasis to the skin is a rare event and to our knowledge, there are less than 30 cases of GBM metastasizing to cutaneous or subcutaneous tissue described in the literature. None of these cases were diagnosed and/or treated in the Middle East region; and the majority of the metastases found were adjacent to the site of surgery undergone to remove the primary malignancy. We present the case of a 53-year-old male diagnosed with GBM and later showing signs of metastases at the anterio-auricular side of his face near-distant from the site of previous surgery done to remove the primary tumor.
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Affiliation(s)
- Clara El Nakib
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Hajjar
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maroun Bou Zerdan
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hussein Darwish
- Department of Neurosurgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Youssef Zeidan
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Saada Alame
- Department of Pediatrics, Lebanese University, Beirut, Lebanon
| | - Hala Kfoury Kassouf
- Department of Pathology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nathalie Chamseddine
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hazem I. Assi
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon,Corresponding author
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4
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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.
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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.
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5
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Turk O, Ozdemir NG, Atci IB, Yilmaz H, Gunver F, Antar V, Yilmaz A. A rare case of cervical metastatis of glioblastoma after cranial tumor resection: case report and review of literature. Br J Neurosurg 2020; 35:341-347. [PMID: 32870037 DOI: 10.1080/02688697.2020.1814994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults. GBM extraneural metastases occur in only approximately 0.2-0.4% of patients. We present a case of a cervical metastasis of glioblastoma after cranial tumor resection. In concord with case presentation, we reviewed the metastatic location and metastasis time of the gliablastomas seen in the literature.
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Affiliation(s)
- Okan Turk
- Department of Neurosugery, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Nuriye Guzin Ozdemir
- Department of Neurosugery, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Ibrahim Burak Atci
- Department of Neurosugery, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Hakan Yilmaz
- Department of Neurosurgery, Usak University Education and Research Hospital, Usak, Turkey
| | - Feray Gunver
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Veysel Antar
- Department of Neurosugery, Istanbul Education and Research Hospital, Istanbul, Turkey
| | - Adem Yilmaz
- Department of Neurosugery, Istanbul Education and Research Hospital, Istanbul, Turkey
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6
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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.
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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.
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7
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Choi MG, Lee JH, Lee MS, Suh SJ, Lee YS, Kang DG. Primary Gliosarcoma with Extracranial Metastasis. Brain Tumor Res Treat 2020; 8:53-56. [PMID: 32390354 PMCID: PMC7221469 DOI: 10.14791/btrt.2020.8.e9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 11/20/2022] Open
Abstract
A 69-year-old male presented with a week of worsening headache, mild dizziness and left side weakness, and the radiological work-up of his brain displayed an enhancing mass on the right frontal lobe. The tumor was totally resected. The patient was initially diagnosed with glioblastoma multiforme. His neurologic symptoms recovered after surgery. He underwent adjuvant radiotherapy with concurrent temozolomide. Approximately 7 months after surgery, the patient complained of epigastric pains. Abdominal CT scan showed multiple hepatic metastasis and multiple lymphadenopathy. Chest CT and Torso positron emission tomography-CT scans for additional metastasis study revealed multiple metastatic lesions in the right lung, left pleura, liver, lymph nodes, bones, and muscles. Percutaneous liver biopsy was performed, and associated pathology was consistent with sarcomatous component. After liver biopsy, brain tumor pathology was reviewed, which revealed typical gliomatous and sarcomatous components. The patient was therefore diagnosed with metastatic gliosarcoma. The patient was in a septic condition with aggravated pleural effusion. The patient died 9 months after the diagnosis of primary gliosarcoma.
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Affiliation(s)
- Min Gyu Choi
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jeong Ho Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea.
| | - Min Seok Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sang Jun Suh
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Yoon Soo Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Dong Gee Kang
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
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8
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Magdaleno-Tapial J, Valenzuela-Oñate C, Pérez-Pastor G, Alegre de Miquel V. Skin Metastasis of Glioblastoma Multiforme: A Case Report and Literature Review. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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9
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Magdaleno-Tapial J, Valenzuela-Oñate C, Pérez-Pastor G, Alegre de Miquel V. Metástasis cutánea de glioblastoma multiforme: presentación de un caso y revisión de la literatura. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:780-783. [DOI: 10.1016/j.ad.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 01/15/2018] [Accepted: 05/23/2018] [Indexed: 10/27/2022] Open
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10
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Umbach G, El Ahmadieh TY, Plitt AR, Aoun SG, Neeley OJ, Lyon KA, Fonkem E, Raisanen JM, Bishop JA, Wardak Z, Patel TR, Myers L, Mickey BE. Extraneural metastatic anaplastic ependymoma: a systematic review and a report of metastases to bilateral parotid glands. Neurooncol Pract 2019; 7:218-227. [PMID: 32626590 DOI: 10.1093/nop/npz041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Anaplastic ependymoma with extraneural metastases is associated with a poor clinical outcome. Metastatic spread to the parotid gland is a rare clinical entity that requires multidisciplinary intervention. Herein, we present a systematic review of anaplastic ependymoma with extraneural metastases and report on a case with metastases to both parotid glands. Methods Electronic databases were searched from their inception to February 2019. Inclusion criteria included reports of anaplastic ependymoma with extraneural metastasis. Studies were excluded if the tumor grade was not reported. A case illustration is provided. Results The search yielded 15 cases of anaplastic ependymoma with extraneural metastases, including the present case. Mean age at diagnosis was 15 years. The initial tumor location was predominantly supratentorial (93.3%). All cases demonstrated leptomeningeal seeding before extraneural metastasis. Mean survival from initial diagnosis was 4.5 years. Metastasis to the parotid gland occurred in 2 cases, including the present case. We present a 17-year-old female patient who underwent gross total resection of a supratentorial, paraventricular anaplastic ependymoma followed by adjuvant external beam radiation therapy. The patient developed recurrent leptomeningeal seeding, treated with Gamma Knife radiosurgery over a 5-year period. She returned with a parotid mass and cervical lymphadenopathy and underwent parotidectomy and modified radical neck dissection. She continued to experience recurrences, including the left parotid gland, and was ultimately placed in hospice care. Conclusions Anaplastic ependymoma with extraneural metastasis is rare. A combination of repeated surgical resection, radiation therapy, and chemotherapy can be used to manage recurrent and metastatic disease, but outcomes remain poor.
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Affiliation(s)
- Gray Umbach
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Tarek Y El Ahmadieh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Aaron R Plitt
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Salah G Aoun
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Om J Neeley
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott and White Health, Temple, Texas
| | - Ekokobe Fonkem
- Department of Neurosurgery, Baylor Scott and White Health, Temple, Texas
| | - Jack M Raisanen
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas
| | - Zabi Wardak
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Toral R Patel
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
| | - Larry Myers
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas
| | - Bruce E Mickey
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas
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11
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Rosen J, Blau T, Grau SJ, Barbe MT, Fink GR, Galldiks N. Extracranial Metastases of a Cerebral Glioblastoma: A Case Report and Review of the Literature. Case Rep Oncol 2018; 11:591-600. [PMID: 30283316 PMCID: PMC6167720 DOI: 10.1159/000492111] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 07/15/2018] [Indexed: 01/09/2023] Open
Abstract
The glioblastoma, a malignant human brain tumor, is known for its devastating intracranial progress and its dismal prognosis. Whereas treatment and research are most prominently focused on the primary tumor lesion, in recent years evidence has accumulated that points to the rare occurrence of extracranial glioblastoma metastases. We here present a case of a female patient with a known glioblastoma who was detected to harbor multiple metastases in the bones, lung, pleura, liver, mesentery, and the subcutaneous soft tissue. Pathogenetically, these metastatic lesions developed most probably after a local progression of the left temporal glioblastoma through the skull base, thus getting access to the systemic lymphatics. Similar cases of extensive glioblastoma metastization, their putative underlying mechanisms, and implications for clinical care are discussed.
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Affiliation(s)
- Jurij Rosen
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Tobias Blau
- Institute of Neuropathology, University of Cologne, Cologne, Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany.,Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany
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12
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Lewis GD, Rivera AL, Tremont-Lukats IW, Ballester-Fuentes LY, Zhang YJ, Teh BS. GBM skin metastasis: a case report and review of the literature. CNS Oncol 2017; 6:203-209. [PMID: 28718312 PMCID: PMC6009214 DOI: 10.2217/cns-2016-0042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/20/2017] [Indexed: 12/11/2022] Open
Abstract
Glioblastoma (GBM) is the most common type of malignant tumor found in the brain, and acts very aggressively by quickly and diffusely infiltrating the surrounding brain parenchyma. Despite its aggressive nature, GBM is rarely found to spread extracranially and develop distant metastases. The most common sites of these rare metastases are the lungs, pleura and cervical lymph nodes. There are also a few case reports of skin metastasis. We present the clinical, imaging and pathologic features of a case of a GBM with metastasis to the soft tissue scar and skin near the original craniotomy site. In addition, we discuss the details of this case in the context of the previously reported literature.
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Affiliation(s)
- Gary D Lewis
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Andreana L Rivera
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Ivo W Tremont-Lukats
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA
- Kenneth R. Peak Center for Brain & Pituitary Tumors, Houston, TX 77030, USA
| | | | - Yi Jonathan Zhang
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA
- Kenneth R. Peak Center for Brain & Pituitary Tumors, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
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13
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Rennert RC, Hoshide RR, Signorelli JW, Amaro D, Sack JA, Brennan CW, Chen CC. Concurrence of chromosome 6 chromothripsis and glioblastoma metastasis. J Neurosurg 2017; 126:1472-1478. [DOI: 10.3171/2016.4.jns153052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report an unusual case of a widely metastatic glioblastoma. DNA copy number microarray profile of the resected specimen revealed complex rearrangements found throughout chromosome 6, a phenomenon known as chromothripsis. Such chromothripsis pattern was not observed in 50 nonmetastatic glioblastoma specimens analyzed. Analysis of the 1000+ gliomas profiled by The Cancer Genome Atlas (TCGA) data set revealed one case of chromosome 6 chromothripsis resembling the case described here. This TCGA patient died within 6 months of undergoing tumor resection. Implications of these findings are reviewed in the context of the current literature.
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Affiliation(s)
| | | | | | - Deirdre Amaro
- 2Pathology, University of California, San Diego, California; and
| | | | - Cameron W. Brennan
- 3Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
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14
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Strowd RE, Strowd LC, Blakeley JO. Cutaneous manifestations in neuro-oncology: clinically relevant tumor and treatment associated dermatologic findings. Semin Oncol 2016; 43:401-7. [PMID: 27178695 DOI: 10.1053/j.seminoncol.2016.02.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Skin findings are a rare but important aspect of the evaluation and management of patients with tumors of the nervous system. Skin findings have the highest prevalence in genetic tumor syndromes termed neuro-genodermatoses, which include neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and tuberous sclerosis. Skin changes are observed in patients with non-syndromic nervous system malignancy, often as a result of pharmacotherapy. The skin may also manifest findings in paraneoplastic conditions that affect the nervous system, providing an early indication of underlying neoplasm, including dermatomyosistis, neuropathic itch, and brachioradial pruritus. In this article, we review the major cutaneous findings in patients with tumors of the brain, spine, and peripheral nervous system focusing on (1) cutaneous manifestations of genetic and sporadic primary nervous system tumor syndromes, and (2) paraneoplastic neurological syndromes with prominent cutaneous features.
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Affiliation(s)
- Roy E Strowd
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC; Department of Neurology and Oncology, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Lindsay C Strowd
- Department of Dermatology, Wake Forest Baptist Medical Center, Winston Salem, NC
| | - Jaishri O Blakeley
- Department of Neurology, Wake Forest School of Medicine, Winston Salem, NC; Department of Neurology and Oncology, Johns Hopkins School of Medicine, Baltimore, MD
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15
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Wang TL, Lin CL, Tsai SY, Lieu AS. Regional skin invasion by glioblastoma multiforme. FORMOSAN JOURNAL OF SURGERY 2015. [DOI: 10.1016/j.fjs.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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16
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Extraneural metastases in glioblastoma patients: two cases with YKL-40-positive glioblastomas and a meta-analysis of the literature. Neurosurg Rev 2015. [PMID: 26212701 DOI: 10.1007/s10143-015-0656-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Glioblastoma (GBM) are high-grade gliomas that severely impact on overall survival (OS). GBM cell motility and the breakdown of the blood-brain barrier could favor GBM cell communication with the systemic circulation. In spite of this, extracranial GBM metastases are rare. Here, we describe two YKL-40-positive GBM patients with extra-CNS (central nervous system) metastases, and we present a meta-analysis of 94 cases. The analysis concluded that extra-CNS metastases occurred 8.5 months after first GBM diagnosis and OS was 12 months; surgical GBM excision was associated at a longer interval to extra-CNS metastasis than biopsy only, and even longer if followed by radiotherapy and chemotherapy. Both our case reports were adult males who developed extra-CNS, YKL-40-positive metastases at lymph nodes, lung and subcutaneous sites, after 86 and 24 months from initial diagnosis of GBM. At first GBM local recurrence, they were treated with bevacizumab (BV), an anti-vascular endothelial growth factor antibody. They died after 4 and 1 month from the occurrence of metastases. Both cases expressed YKL-40 and lacked EGFR amplification, suggesting a mesenchymal phenotype, and maintained such profile at extra-CNS recurrence; they did not show MGMT promoter methylation, IDH1/2 mutations, or c-Met upregulation. Our two cases and the meta-analysis support the idea that prolonged survival of GBM patients increases the probability of GBM cells shedding to lymphatic and hematic system. Interestingly, the present two cases showed the features of mesenchymal profile, usually related with worst prognosis that was maintained in extracranial metastases.
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17
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Avecillas-Chasin JM, Saceda-Gutierrez J, Alonso-Lera P, Garcia-Pumarino R, Issa S, López E, Barcia JA. Scalp Metastases of Recurrent Meningiomas: Aggressive Behavior or Surgical Seeding? World Neurosurg 2015; 84:121-31. [DOI: 10.1016/j.wneu.2015.02.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 01/16/2023]
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18
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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.
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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
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Kim W, Yoo H, Shin SH, Gwak HS, Lee SH. Extraneural Metastases of Glioblastoma without Simultaneous Central Nervous System Recurrence. Brain Tumor Res Treat 2014; 2:124-7. [PMID: 25408938 PMCID: PMC4231629 DOI: 10.14791/btrt.2014.2.2.124] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/12/2014] [Accepted: 09/23/2014] [Indexed: 12/01/2022] Open
Abstract
Glioblastoma multiforme (GBM) is well known as the most common malignant primary brain tumor. It could easily spread into the adjacent or distant brain tissue by infiltration, direct extension and cerebro-spinal fluid dissemination. The extranueural metastatic spread of GBM is relatively rare but it could have more progressive disease course. We report a 39-year-old man who had multiple bone metastases and malignant pleural effusion of the GBM without primary site recurrence.
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Affiliation(s)
- Wonki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Heon Yoo
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sang Hoon Shin
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Shin Gwak
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seung Hoon Lee
- Neuro-Oncology Clinic, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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Glioblastoma multiforme - an overview. Contemp Oncol (Pozn) 2014; 18:307-12. [PMID: 25477751 PMCID: PMC4248049 DOI: 10.5114/wo.2014.40559] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 02/15/2013] [Accepted: 12/17/2013] [Indexed: 12/12/2022] Open
Abstract
Glioblastoma multiforme is a central nervous system tumor of grade IV histological malignancy according to the WHO classification. Over 90% of diagnosed glioblastomas multiforme cases are primary gliomas, arising from normal glial cells through multistep oncogenesis. The remaining 10% are secondary gliomas originating from tumors of lower grade. These tumors expand distinctly more slowly. Although genetic alterations and deregulations of molecular pathways leading to both primary and secondary glioblastomas formation differ, morphologically they do not reveal any significant differences. Glioblastoma is a neoplasm that occurs spontaneously, although familial gliomas have also been noted. Caucasians, especially those living in industrial areas, have a higher incidence of glioblastoma. Cases of glioblastoma in infants and children are also reported. The participation of sex hormones and viruses in its oncogenesis was also suggested. Progression of glioblastoma multiforme is associated with deregulation of checkpoint G1/S of a cell cycle and occurrence of multiple genetic abnormalities of tumor cells. Metastases of glioblastoma multiforme are rarely described. Treatment of glioblastoma multiforme includes tumor resection, as well as radiotherapy and chemotherapy. Drugs inhibiting integrin signaling pathways and immunotherapy are also employed. Treatment modalities and prognosis depend on the tumor localization, degree of its malignancy, genetic profile, proliferation activity, patient's age and the Karnofsky performance scale score. Although the biology of glioblastoma multiforme has recently been widely investigated, the studies summarizing the knowledge of its development and treatment are still not sufficient in terms of comprehensive brain tumor analysis.
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Romero-Rojas AE, Diaz-Perez JA, Amaro D, Lozano-Castillo A, Chinchilla-Olaya SI. Glioblastoma metastasis to parotid gland and neck lymph nodes: fine-needle aspiration cytology with histopathologic correlation. Head Neck Pathol 2013; 7:409-15. [PMID: 23637061 PMCID: PMC3824794 DOI: 10.1007/s12105-013-0448-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 04/26/2013] [Indexed: 11/24/2022]
Abstract
Glioblastoma (GBM) is one of the most highly aggressive neoplasms of the central nervous system. Extra-cranial metastases in GBM are rare. Here we present the case of a 26-year-old man with extra-cranial metastasis of a frontal lobe GBM to the parotid gland, cervical lymph nodes, and bones, with initial diagnosis made by fine needle aspiration cytology (FNAC) of the parotid gland. FNAC is a reliable technique in the study of primary and secondary parotid gland neoplasms, allowing a presumptive diagnosis in difficult cases. We correlate the cytologic, histopathologic, and immunohistochemical findings in this case and discuss previous literature reports.
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Affiliation(s)
| | - Julio A. Diaz-Perez
- />National Institute of Cancer, Bogotá, Colombia , />University of California, San Diego, Stein Clinical Research Building 245, 9500 Gilman Drive, La Jolla, CA 92093-0637 USA , />University of Santander, Bucaramanga, Colombia
| | - Deirdre Amaro
- />University of California, San Diego, Stein Clinical Research Building 245, 9500 Gilman Drive, La Jolla, CA 92093-0637 USA
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22
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Sloan AE, Ahluwalia MS, Valerio-Pascua J, Manjila S, Torchia MG, Jones SE, Sunshine JL, Phillips M, Griswold MA, Clampitt M, Brewer C, Jochum J, McGraw MV, Diorio D, Ditz G, Barnett GH. Results of the NeuroBlate System first-in-humans Phase I clinical trial for recurrent glioblastoma: clinical article. J Neurosurg 2013; 118:1202-19. [PMID: 23560574 DOI: 10.3171/2013.1.jns1291] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Laser interstitial thermal therapy has been used as an ablative treatment for glioma; however, its development was limited due to technical issues. The NeuroBlate System incorporates several technological advances to overcome these drawbacks. The authors report a Phase I, thermal dose-escalation trial assessing the safety and efficacy of NeuroBlate in recurrent glioblastoma multiforme (rGBM). METHODS Adults with suspected supratentorial rGBM of 15- to 40-mm dimension and a Karnofsky Performance Status score of ≥ 60 were eligible. After confirmatory biopsy, treatment was delivered using a rigid, gas-cooled, side-firing laser probe. Treatment was monitored using real-time MRI thermometry, and proprietary software providing predictive thermal damage feedback was used by the surgeon, along with control of probe rotation and depth, to tailor tissue coagulation. An external data safety monitoring board determined if toxicity at lower levels justified dose escalation. RESULTS Ten patients were treated at the Case Comprehensive Cancer Center (Cleveland Clinic and University Hospitals-Case Medical Center). Their average age was 55 years (range 34-69 years) and the median preoperative Karnofsky Performance Status score was 80 (range 70-90). The mean tumor volume was 6.8 ± 5 cm(3) (range 2.6-19 cm(3)), the percentage of tumor treated was 78% ± 12% (range 57%-90%), and the conformality index was 1.21 ± 0.33 (range 1.00-2.04). Treatment-related necrosis was evident on MRI studies at 24 and 48 hours. The median survival was 316 days (range 62-767 days). Three patients improved neurologically, 6 remained stable, and 1 worsened. Steroid-responsive treatment-related edema occurred in all patients but one. Three had Grade 3 adverse events at the highest dose. CONCLUSIONS NeuroBlate represents new technology for delivering laser interstitial thermal therapy, allowing controlled thermal ablation of deep hemispheric rGBM. CLINICAL TRIAL REGISTRATION NO.: NCT00747253 ( ClinicalTrials.gov ).
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Affiliation(s)
- Andrew E Sloan
- Brain Tumor & Neuro-Oncology Center and Department of Neurosurgery, University Hospitals Case Medical Center, Seidman Cancer Center, Cleveland, Ohio, USA
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23
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Ginat DT, Kelly HR, Schaefer PW, Davidson CJ, Curry W. Recurrent scalp metastasis from glioblastoma following resection. Clin Neurol Neurosurg 2013; 115:461-3. [DOI: 10.1016/j.clineuro.2012.05.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 05/07/2012] [Accepted: 05/28/2012] [Indexed: 12/01/2022]
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Guo L, Qiu Y, Ge J, Zhou D. Glioblastoma multiforme with subcutaneous metastases, case report and literature review. J Korean Neurosurg Soc 2012; 52:484-7. [PMID: 23323171 PMCID: PMC3539085 DOI: 10.3340/jkns.2012.52.5.484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 07/06/2012] [Accepted: 10/31/2012] [Indexed: 11/27/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common primary brain tumor and the most malignant astrocytoma in adults, with rare extra-cranial metastases, especially for subcutaneous metastases. It could be easily misdiagnosed as primary subcutaneous tumor. In this report, we describe a patient with pontine GBM who developed a subcutaneous swelling at the ipsilateral posterior cervical region 8 months after operation, and the pathological and immunocytochemical examination carry the same characteristics as the primary intracranial GBM cells, which defined it as subcutaneous metastasis. GBM with subcutaneous metastasis is extremely rare, and knowledge of a prior intracranial GBM, pathological examinations and immunocytochemical tests with markers typically expressed by GBM are of vital importance for the diagnosis of GBM metastasis. Surgical resection of subcutaneous swelling, followed by chemotherapy and radiotherapy, could be the best strategy of treatment for the patients with GBM subcutaneous metastasis.
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Affiliation(s)
- Liemei Guo
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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26
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Cutaneous metastases from internal malignancies: a clinicopathologic and immunohistochemical review. Am J Dermatopathol 2012; 34:347-93. [PMID: 22617133 DOI: 10.1097/dad.0b013e31823069cf] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skin metastases occur in 0.6%-10.4% of all patients with cancer and represent 2% of all skin tumors. Skin metastases from visceral malignancies are important for dermatologists and dermatopathologists because of their variable clinical appearance and presentation, frequent delay and failure in their diagnosis, relative proportion of different internal malignancies metastasizing to the skin, and impact on morbidity, prognosis, and treatment. Another factor to take into account is that cutaneous metastasis may be the first sign of clinically silent visceral cancer. The relative frequencies of metastatic skin disease tend to correlate with the frequency of the different types of primary cancer in each sex. Thus, women with skin metastases have the following distribution in decreasing order of frequency of primary malignancies: breast, ovary, oral cavity, lung, and large intestine. In men, the distribution is as follows: lung, large intestine, oral cavity, kidney, breast, esophagus, pancreas, stomach, and liver. A wide morphologic spectrum of clinical appearances has been described in cutaneous metastases. This variable clinical morphology included nodules, papules, plaques, tumors, and ulcers. From a histopathologic point of view, there are 4 main morphologic patterns of cutaneous metastases involving the dermis, namely, nodular, infiltrative, diffuse, and intravascular. Generally, cutaneous metastases herald a poor prognosis. The average survival time of patients with skin metastases is a few months. In this article, we review the clinicopathologic and immunohistochemical characteristics of cutaneous metastases from internal malignancies, classify the most common cutaneous metastases, and identify studies that may assist in diagnosing the origin of a cutaneous metastasis.
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28
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Seo YJ, Cho WH, Kang DW, Cha SH. Extraneural metastasis of glioblastoma multiforme presenting as an unusual neck mass. J Korean Neurosurg Soc 2012; 51:147-50. [PMID: 22639711 PMCID: PMC3358601 DOI: 10.3340/jkns.2012.51.3.147] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 09/14/2011] [Accepted: 03/08/2012] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and it commonly spreads by direct extension and infiltration into the adjacent brain tissue and along the white matter tract. The metastatic spread of GBM outside of the central nervous system (CNS) is rare. The possible mechanisms of extraneural metastasis of the GBM have been suggested. They include the lymphatic spread, the venous invasion and the direct invasion through dura and bone. We experienced a 46-year-old man who had extraneural metastasis of the GBM on his left neck. The patient was treated with surgery for 5 times, radiotherapy and chemotherapy. He had survived 6 years since first diagnosed. Although the exact mechanism of the extraneural metastasis is not well understood, this present case shows the possibility of extraneural metastasis of the GBM, especially in patients with long survival.
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Affiliation(s)
- Young Jun Seo
- Department of Neurosurgery & Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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29
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Jusué Torres I, Jerez Fernández P, Ortega Zufiría J, Rodríguez Barbero JM. Skin spread from an intracranial glioblastoma: case report and review of the literature. BMJ Case Rep 2011; 2011:bcr.09.2011.4858. [PMID: 22675113 DOI: 10.1136/bcr.09.2011.4858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extracranial metastases secondary to intracranial neoplasm are extremely rare. The incidence of extraneural metastases of brain tumours is estimated to be less than 0.4%. The authors report a case of postoperative intracranial glioblastoma spreading to the skin in an adult patient. In this case, the radiological images and surgical findings suggest that the potential dissemination mechanism is as a result of infiltration through the surgical wound site. The primary tumour-upon coming into contact with the dura and the skin-mimicked the characteristics of both tissues. This case supports the theory of risk of spread through the durotomy site, although this phenomenon is extremely rare. Both the specific pathogenic mechanisms as well as the ideal and effective management have not been established yet and require further investigation.
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Keiner D, Gaab MR, Backhaus V, Piek J, Oertel J. Water jet dissection in neurosurgery: an update after 208 procedures with special reference to surgical technique and complications. Neurosurgery 2011; 67:342-54. [PMID: 21099557 DOI: 10.1227/neu.0b013e3181f743bb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Water jet dissection represents a promising technique for precise brain tissue dissection with preservation of blood vessels. In the past, the water jet dissector has been used for various pathologies. A detailed report of the surgical technique is lacking. OBJECTIVE The authors present their results after 208 procedures with a special focus on surgical technique, intraoperative suitability, advantages, and disadvantages. METHODS Between March 1997 and April 2009, 208 patients with various intracranial neurosurgical pathologies were operated on with the water jet dissector. Handling of the device and its usefulness and extent of application were assessed. The pressures encountered, potential risks, and complications were documented. The patients were followed 1 to 24 months postoperatively. RESULTS A detailed presentation of the surgical technique is given. Differences and limitations of the water jet dissection device in the various pathologies were evaluated. The water jet dissector was intensively used in 127 procedures (61.1%), intermittently used in 56 procedures (26.9%), and scarcely used in 25 procedures (12%). The device was considered to be very helpful in 166 procedures (79.8%) and helpful to some extent in 33 procedures (15.9%). In 8 (3.8%) procedures, it was not helpful, and in 1 procedure (0.5%), the usefulness was not documented by the surgeon. CONCLUSION The water jet dissector can be applied easily and very safely. Precise tissue dissection with preservation of blood vessels and no greater risk of complications are possible. However, the clinical consequences of the described qualities need to be demonstrated in a randomized clinical trial.
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Affiliation(s)
- Doerthe Keiner
- Department of Neurosurgery, Johannes-Gutenberg-University, Mainz, Germany
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31
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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.
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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
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Subcutaneous tumor seeding after biopsy in gliomatosis cerebri. J Neurooncol 2011; 106:431-5. [PMID: 21837541 PMCID: PMC3230756 DOI: 10.1007/s11060-011-0678-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Accepted: 07/30/2011] [Indexed: 01/03/2023]
Abstract
We observed a patient with subcutaneous seeding from gliomatosis cerebri with a low-grade histopathology. A 33-year-old woman with neurofibromatosis type 1 presented with progressive headache, diplopia, dysphagia, and a rightward instability. On neurological examination dysarthria, gait ataxia, and left-sided central facial and hypoglossal palsies were determined. MRI of the brain demonstrated diffuse, infiltrative non-enhancing lesions in the pons, both cerebellar hemispheres, the parahippocampal gyrus, and the thalamus. A stereotactic biopsy demonstrated an astrocytoma WHO grade 2. These characteristics confirmed gliomatosis cerebri. Three months later, the patient presented with hydrocephalus and a subcutaneous swelling directly underneath the surgical scar. The subcutaneous swelling was removed and the hydrocephalus was treated by ventriculoperitoneal shunting. Histopathological examination confirmed a subcutaneous manifestation of low-grade oligoastrocytoma. Gliomatosis cerebri with low-grade histology can seed subcutaneously.
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Chao MM, Packer RJ, Myseros JS, Rood BR. Isolated extracranial recurrence of anaplastic ependymoma. Pediatr Blood Cancer 2011; 56:317-8. [PMID: 20830772 DOI: 10.1002/pbc.22764] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anaplastic ependymoma is a malignant glial tumor thought to arise from radial glial cells of the ventricular zone. Because ependymoma is frequently encountered within ventricular spaces, they are prone to leptomeningeal dissemination. Metastatic extracranial ependymoma has been reported, but in the context of progressive intracranial disease. We report on a boy who developed isolated extracranial recurrence of his anaplastic ependymoma, initially at the scalp and later metastases to cervical lymph nodes. The location of tumor recurrence proximate to the surgical site suggested surgical seeding. This case demonstrates an unusual site of recurrence of anaplastic ependymoma and highlights a previously underappreciated surgical complication.
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Affiliation(s)
- Mwe Mwe Chao
- Children's National Medical Center, Division of Pediatric Oncology, Washington, District of Columbia 20010, USA.
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34
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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.
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Affiliation(s)
- Patrick Beauchesne
- Neuro-Oncology, CHU de NANCY, Hôpital Central, CO n°34, 54035 Nancy Cedex, France.
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Davis MJ, Hasan F, Weinreb I, Wallace MC, Kiehl TR. Extraventricular anaplastic ependymoma with metastasis to scalp and neck. J Neurooncol 2011; 104:599-604. [PMID: 21222217 DOI: 10.1007/s11060-010-0525-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 12/30/2010] [Indexed: 02/01/2023]
Abstract
We report a case of anaplastic ependymoma with extracranial metastases in a 22-year-old female. The patient originally presented with headaches and dysarthria. Neuroimaging revealed a large solid and cystic right fronto-temporal lesion. It was located completely extraventricularly and a glioblastoma was suspected based on the neuroimaging findings. A gross total resection was achieved. Histopathologic examination revealed an anaplastic ependymoma. The patient was treated with radiotherapy. Approximately 1 year after the initial surgery, the patient presented with metastatic disease to the scalp. At 2 years, an intraparotid metastasis was detected. Subsequent neck dissection revealed positive lymph nodes at several levels. It was followed by radiotherapy to the neck. 5 years after the initial surgery, the patient has residual metastatic disease. The case is discussed and the literature on extraventricular ependymal neoplasms is reviewed.
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Affiliation(s)
- Matthew J Davis
- The Ruth and Bruce Rappaport Faculty of Medicine Technion - Israel Institute of Technology, 12 Efron St., Haifa, 31096, Israel
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Armstrong TS, Prabhu S, Aldape K, Hossan B, Kang S, Childress A, Tolentino L, Gilbert MR. A case of soft tissue metastasis from glioblastoma and review of the literature. J Neurooncol 2010; 103:167-72. [PMID: 20809248 DOI: 10.1007/s11060-010-0370-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Abstract
Despite recent advances, glioblastoma (GBM) remains incurable but is typically characterized by local tumor recurrence in the brain. Soft tissue metastases from GBM are extremely rare, with only eight reported cases in the literature. It has been postulated that this type of metastases rarely occurs due to inability of tumor cells to survive outside the brain milieu, physical barriers preventing tumor spread, and/or early patient death from this aggressive tumor. Here we present another case of soft tissue metastases that occurred in a young woman with GBM and review the previous literature.
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Affiliation(s)
- Terri S Armstrong
- Department of Integrative Nursing Care, University of Texas at Houston School of Nursing, Houston, USA.
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Metastatic Gliosarcoma Mass Extension to a Donor Fascia Lata Graft Harvest Site by Tumor Cell Contamination. World Neurosurg 2010; 73:719-21. [DOI: 10.1016/j.wneu.2010.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 03/13/2010] [Indexed: 11/20/2022]
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Senetta R, Trevisan E, Rudà R, Benech F, Soffietti R, Cassoni P. Skin metastases of glioblastoma in the absence of intracranial progression are associated with a shift towards a mesenchymal immunophenotype: report of two cases. Acta Neuropathol 2009; 118:313-6. [PMID: 19418061 DOI: 10.1007/s00401-009-0543-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 04/22/2009] [Accepted: 04/22/2009] [Indexed: 11/25/2022]
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Da Fonseca CO, Silva JT, Lins IR, Simão M, Arnobio A, Futuro D, Quirico-Santos T. Correlation of tumor topography and peritumoral edema of recurrent malignant gliomas with therapeutic response to intranasal administration of perillyl alcohol. Invest New Drugs 2009; 27:557-64. [PMID: 19139816 DOI: 10.1007/s10637-008-9215-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 12/19/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of this study was to establish a correlation of tumor topography and peritumoral brain edema with the therapeutic response to intranasal administration of perillyl alcohol (POH) in a cohort of patients with recurrent malignant gliomas. METHODS The retrospective study reviewed clinical and neuroradiological data from patients with recurrent malignant gliomas who received intranasal daily administration of POH 440 mg. The following parameters were assessed: demographic characteristics, initial symptoms, overall survival, tumor topography and tumor size, presence of midline shift and extent of peritumoral edema. Statistical analysis was carried out with log rank tests and overall survival as assessed by Kaplan-Meier method including 95% confidence intervals. RESULTS A cohort of 67 patients included 52 (78%) with glioblastoma (GBM), ten (15%) with anaplastic astrocytoma (AA) and five (7%) with anaplastic oligodendroglioma (AO). Accordingly to tumor topography lobar localization was present in all (5/5) AO; eight (8/10) and 41 GBM patients whereas in the basal ganglia two AA and 11 GBM patients. It was also observed a relation between the tumor size and area of peritumoral brain edema (PTBE). Patients with good therapeutic response showed reduction of tumor size and PTBE area, but poor prognosis was associated with lack of response to treatment and persistence of high PTBE. Patients with tumor in the basal ganglia survived significantly longer than those with lobar gliomas (log rank test, p = 0.0003). Presence of midline shift (>1 cm) was a statistically significant risk factor for shorter survival (log rank test, p = 0.0062) CONCLUSIONS This study suggests that: (1) patients with recurrent gliomas with localization in the basal ganglia survive significantly longer than those with tumors at lobar localization; (2) presence of PTBE contributes to symptoms, likely to be implicated in the morbidity and invading potential of malignant gliomas. These findings support the theory that interaction between glioma cells at distinct brain microenvironment can influence the oncobiological behavior of glioma cells and ultimately to the prognosis.
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Affiliation(s)
- Clovis O Da Fonseca
- Service of Neurosurgery, Department of General and Specialized Surgery, Antonio Pedro University Hospital, Fluminense Federal University, Rua Marques do Paraná 303, 4 andar, Niterói, Rio de Janeiro, Brazil.
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