Rare Case of Extracranial Metastases in a Patient with IDH-Mutant Glioblastoma

Abstract

Glioblastoma are known for its aggressive intracranial course of disease, where the overall survival is less than 18 months. Of late, the World Health Organization has reclassified and renamed secondary glioblastomas as isocitrate dehydrogenase (IDH)-mutant grade 4 astrocytomas, which is relatively better than its IDH wild-type counterpart; however, overall survival remains poor. In such tumors, metastases outside the craniospinal neuraxis is very rare, and does sometimes present with symptoms which create a diagnostic dilemma and arriving at such diagnosis is still challenging even for the best of the clinicians worldwide. Here we present such a rare case scenario, where a grade 4 astrocytoma that has transformed from a low-grade glioma, presenting with bone metastases, its workup, treatment, and various possible mechanisms underlying such a rare event, and the need of such clinical scenario especially long-term survivors to be wary of distant metastases.

Unusual Extra-Axial and Extracranial Recurrence in an IDH Mutant Astrocytoma: A Case Report

“…Common sites include the lymph nodes, bone, soft tissue, skin, and liver. 22 23 In skeletal metastases, vertebral bodies are most commonly involved, 24 likely through seeding from the Bateson plexus. 24 Spread via breakdown of the blood–brain barrier via tumoral vessels or invasion of dural veins, lymphogenous, and hematogenous spread by direct extracranial bone and soft tissue infiltration, through the CSF, by ventricular shunting are proposed mechanisms.…”