Brain Stem and Entire Spinal Leptomeningeal Dissemination of Supratentorial Glioblastoma Multiforme in a Patient during Postoperative Radiochemotherapy

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.1–3 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.

DNA sequences within glioma-derived extracellular vesicles can cross the intact blood-brain barrier and be detected in peripheral blood of patients

“…In this context, some groups have recently postulated the use of CSF as a source of tumor-derived DNA sequences [ 19 , 21 ]. However, the lumbar puncture is often unfeasible in glioma patients mostly due to the high intracranial pressure [ 28 ].…”

Combining therapy with recombinant human endostatin and cytotoxic agents for recurrent disseminated glioblastoma: a retrospective study

“…In addition, this study did not focus on one chemotherapy regimen and fail to provide an effective therapeutic approach [17]. Most of the other published studies were case reports [18][19][20]. Okita Y reported a case of leptomeningeal dissemination of recurrent glioblastoma that achieved transient neurological and radiological improvement after chemotherapy with TMZ and bevacizumab (PFS = 2.3 months) and died 5 months after diagnosis of dissemination [18].…”

Combining therapy with recombinant human endostatin and cytotoxic agents for recurrent disseminated glioblastoma: a retrospective study

“…In addition, this study did not focus on one chemotherapy regimen and fail to provide an effective therapeutic approach [17]. Most of the other published studies were case reports [18][19][20].…”