Ascending central nervous spreading of a spinal astrocytoma

Abstract

A 43-year-old man died from the complications of astrocytoma metastasis. He first noticed symptoms of a lumbar disc prolapse in 1979. In 1987 a pilocytic astrocytoma (grade I) of the spinal cauda was removed. In 1989 a tumor recidivation at the same site was partially removed. Histology showed a grade II astrocytoma. Two months later the patient developed symptoms of increased intracerebral pressure. CSF cytology showed polymorphic giant tumor cells with hyperchromatic nuclei and a glioblastoma of the cerebral ventricles was diagnosed. The patient died from cardiovascular complications. The post-mortem investigation revealed an astrocytoma of the conus medullaris with an anaplastic ventral area (grade IV). This area was inaccessible to the biopsy. It is believed that tumor metastases from anaplastic parts spread along the spinal cord and brainstem and finally invaded the brain and cerebral ventricles.

Intracranial Metastases of Cervical Intramedullary Low-Grade Astrocytoma without Malignant Transformation in Adult

“…Santi et al 20) reported that there is a high risk of central nervous system dissemination in patients with spinal cord malignant astrocytoma. Intracranial dissemination of spinal cord low-grade gliomas has been reported very few times 6,19) . When intramedullary low-grade astrocytomas metastasize intracranially, most of them have malignant transformation 6,19) .…”

“…Intracranial dissemination of spinal cord low-grade gliomas has been reported very few times 6,19) . When intramedullary low-grade astrocytomas metastasize intracranially, most of them have malignant transformation 6,19) . In most of the cases reported up until now, spinal cord tumors that spread intracranially had previous malignant transformation or were high-grade gliomas 7,21,24,25) , even though in children, some cases without malignant transformation have been reported 1,2,5,9,11,17) .…”

“…In most of the cases reported up until now, spinal cord tumors that spread intracranially had previous malignant transformation or were high-grade gliomas 7,21,24,25) , even though in children, some cases without malignant transformation have been reported 1,2,5,9,11,17) . In 1995, Claus et al 6) reported the case of a 43-year-old man with intracranial dissemination of a WHO Grade I pilocytic astrocytoma of the cauda equina. Two years after initial resection of the tumor, a second resection was performed for recurrence, and the histological findings from this operation revealed a transformation to a WHO Grade II astrocytoma.…”

“…Cerebral metastases of a primary spinal astrocytoma have rarely been reported 1,6,13,17,19,22,24,25) . Of the spinal cord gliomas reported to have metastasized to the brain, most were anaplastic astrocytomas or glioblastoma multiforme 7,13,19,20,24,25) .…”

“…Of the spinal cord gliomas reported to have metastasized to the brain, most were anaplastic astrocytomas or glioblastoma multiforme 7,13,19,20,24,25) . Seeding to cranial sites from intramedullary low-grade astrocytoma has been reported in only a few cases; these have reported intracranial spread of intramedullary pilocytic astrocytoma without malignant transformation in a child 1,17) and with malignant transformation in an adult 6,19,24) . We report the case of a metastatic spread to the cerebellum of a low-grade astrocytoma without malignant transformation in a 52 year-old male.…”