Spinal metastasis of glioblastoma multiforme before gliosarcomatous transformation: a case report

Abstract

Background: Glioblastoma multiforme (GBM) is one of the most aggressive malignant brain tumors. Intracranial GBM metastases to the spine are rarely detected clinically. Secondary gliosarcomas after treatment of primary GBM are rarely described. Case presentation: Herein, we report the case of a 53-year-old woman who presented to our emergency room with progressive headache and weakness on the left side. Plain computed tomography and contrast magnetic resonance imaging of the brain revealed an approximately 6.8 cm × 4.5 cm right temporoparietooccipital intraaxial cystic tumor with surrounding diffuse perifocal edema that caused midline shift toward the left. Emergency craniotomy was performed to remove the tumor, and pathological examination revealed GBM. The patient received proton beam therapy, Gliadel implantation, and oral temozolomide chemotherapy as well as targeted therapy with bevacizumab. Approximately 15 months after diagnosis, she underwent surgical resection of the right temporal recurrent tumor and was newly diagnosed as having a metastatic spinal tumor. Pathologically, the right temporal and metastatic spinal tumors were gliosarcoma and GBM, respectively. Conclusions: Concurrent spinal metastasis and gliosarcomatous transformation, which are two types of GBM complications, are rare. To our knowledge, this is the first report of a case of recurrent GBM with gliosarcoma after proton bean therapy.

Extracranial metastases in secondary glioblastoma multiforme: a case report

“…This would be in agreement with the hypothesis that the occurrence of metastases from low-grade gliomas may happen before these tumors undergo grade increase, enabling the ability of tumor cells to settle in metastatic sites [ 3 ]. So far, the treatment of extra-CNS metastasis varies widely and there was no substantial treatment progress over the recent decades [ 20 , 21 ]. In our patient, the locoregional radiotherapy allowed good control of lymph node disease even at a distance of about 8–10 months after treatment.…”

Transformation of IDH-wildtype glioblastoma to gliosarcoma with features of osteosarcoma

“…IDH-wildtype glioblastoma is the most common primary malignancy and accounts for approximately 45% of all primary malignant brain tumors in adults. Statistically, it is more common in men than in women [16,20,21]. Studies show that in adults, glioblastoma cells can be derived from neural stem and progenitor cells that are located in the subventricular zone, subcortical white matter and the dentate gyrus of the hippocampus [10,18,23].…”

“…Gomori's silver staining, reaction with vimentin antibody. Gliosarcoma occurs only in approximately 2% of patients diagnosed with glioma [2,7,8,11,14,16], more often in men than in women, with a ratio of 1.8 : 1. It usually appears in the fourth to sixth decade of life [1,2].…”

Role of Polymeric Local Drug Delivery in Multimodal Treatment of Malignant Glioma: A Review

“…1 MGs are highly proliferative and extensively invade the brain parenchyma, resulting in devastating tumor recurrence and poor prognosis with a median survival of approximately 12-15 months. 2,3 Although the standard treatment primarily involves surgical debulking followed by radiation therapy and possible chemotherapy, [4][5][6] a multidisciplinary approach may be required for MGs to be managed efficiently. In the previous decades, multimodal studies and therapeutic trials have been conducted, but the advances have only extended the median survival rate of patients with MG by a few months.…”

“…76 The regimen of administering a chemotherapy agent at a relatively low, minimally toxic dosage for prolonged periods with no extended drug-free interval is called periodic chemotherapy. 77 Using a human melanoma xenograft model, Wedge et al demonstrated that the prolonged administration of O 6 -benzylguanine (O 6 -BG) in combination with TMZ can increase the therapeutic index of TMZ. 35,78,79 However, high drug toxicities and the associated side effects are caused by strategies such as combining different biopharmaceutical agents, increasing the targeted area concentration, and prolonging the treatment.…”