Brain Stem and Entire Spinal Leptomeningeal Dissemination of Supratentorial Glioblastoma Multiforme in a Patient during Postoperative Radiochemotherapy: Case Report and Review of the Literatures.

Abstract

Glioblastoma multiforme (GBM) is the most common primary malignancy of the central nervous system in adults. Macroscopically evident and symptomatic spinal metastases occur rarely. Autopsy series suggest that approximately 25% of patients with intracranial GBM have evidence of spinal subarachnoid seeding, although the exact incidence is not known as postmortem examination of the spine is not routinely performed. Herein, we present a rare case of symptomatic brain stem and entire spinal dissemination of GBM in a 36-year-old patient during postoperative adjuvant radiochemotherapy with temozolomide and cisplatin. Visual deterioration, intractable stomachache, and limb paralysis were the main clinical features. The results of cytological and immunohistochemical tests on the cerebrospinal fluid cells were highly suggestive of spinal leptomeningeal dissemination. After 1 month, the patient's overall condition deteriorated and succumbed to his disease. To the best of our knowledge, this is the first reported case of GBM dissemination presenting in this manner. Because GBM extracranial dissemination is rare, we also reviewed pertinent literature regarding this uncommon entity. Although metastases to spinal cord from GBM are uncommon, it is always important to have in mind when patients with a history of GBM present with symptoms that do not correlate with the primary disease pattern.

• Authors: Xiangyi Kong, Yu Wang, Shuai Liu, Keyin Chen, Qiangyi Zhou, Chengrui Yan, Huayu He, Jun Gao, Jian Guan, Yi Yang, Yongning Li, Bing Xing, Renzhi Wang, Wenbin Ma
• Journal: Medicine (Medicine (Baltimore)) Vol. 94 Issue 24 Pg. e962 (Jun 2015) ISSN: 1536-5964 [Electronic] United States
• PMID: 26091464 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antineoplastic Agents
• Dacarbazine
• Cisplatin
• Temozolomide

Topics

• Adult
• Antineoplastic Agents (therapeutic use)
• Brain Neoplasms (pathology, therapy)
• Brain Stem Neoplasms (secondary)
• Chemoradiotherapy (methods)
• Cisplatin (therapeutic use)
• Dacarbazine (analogs & derivatives, therapeutic use)
• Glioblastoma (pathology, therapy)
• Humans
• Magnetic Resonance Imaging
• Male
• Meningeal Neoplasms (secondary)
• Temozolomide