Cervical Lymph Node Metastasis from A Glioblastoma Multiforme in A Child: Report of A Case and A Review of The Literature

Abstract

AB Jamjoom, ZAB Jamjoom, N-U-Rahman, AC Al-Rikabi, Cervical Lymph Node Metastasis from a Glioblastoma Multiforme in a Child: Report of a Case and a Review of the Literature. 1997; 17(3): 340-343 Glioblastoma multiforme (GM) does not usually metastasize outside the central nervous system (CNS), and is rarer in children than in adults.1 To our knowledge, only 11 cases of childhood GM with extraneural metastasis (ENM) have thus far been reported in the literature. [1][2][3][4] The authors report a case of a four-yearrold male patient with a GM who developed cervical lymph node metastasis seven months after the original presentation. This case and the 11 previously reported pediatric cases were grouped together and their clinical characteristics were compared with the clinical features of the 68 adult cases that have been reported in the literature up to 1995. [4][5][6][7][8] The study is an attempt to identify some of the features of ENM from GM which are unique to children. Case HistoryA four-year-old male Indian patient was admitted to the Neurosurgical Division at King Khalid University Hospital (KKUH) in April 1995 with a one-month history of headache, associated with anorexia and vomiting. On examination, the patient was inactive. He had papilledema and a left homonomous hemianopia but otherwise no neurological deficits. CT scan (Figure 1) showed a large right occipital lesion with irregular contrast enhancement, surrounding edema and mass effect. The patient underwent a craniotomy and total macroscopic excision of a vascular necrotic tumor. Histology (Figure 2) confirmed the tumor to be a glioblastoma multiforme which was focally positive to glial fibrillary acidic protein (GFAP). The postoperative recovery was uneventful and the followup CT scan showed no evidence of any residual tumor.Referral for radiotherapy treatment was made but the child's parents declined the treatment. A month later, the patient was readmitted because of bulging of the bone flap at the site of the craniotomy, which was associated with vomiting. He remained conscious and apart from a left homonomous hemianopia he had no neurological deficits. CT scan showed a large recurrence of the tumor at the same location. The craniotomy was reopened and a total macroscopic excision of the recurrence was performed. There was no evidence of tumor invasion of the dura or the bone flap. The dura was closed and the bone flap was replaced. The postoperative recovery was uneventful and the follow-up CT scan showed no evidence of residual tumor. Histology confirmed the diagnosis of a recurrent glioblastoma multiforme. On this occasion the patient received radiotherapy treatment to the whole cranium (4000 cGy over four weeks, with a daily dose of 200 cGy), and tolerated it well.