Infratentorial Glioblastoma Metastasis to Bone

• Published in: World neurosurgery 2019-11, Vol.131, p.90-94
• Main Authors: Ricard, Jocelyn A, Cramer, Samuel W, Charles, River, Gil Tommee, Carolina, Le, An, Bell, W Robert, Chen, Clark C, Flanagan, Margaret E
• Format: Article
• Language: English
• Subjects: Adult; Bone Neoplasms - diagnostic imaging; Bone Neoplasms - secondary; Glioblastoma - diagnostic imaging; Glioblastoma - genetics; Glioblastoma - secondary; Glioblastoma - therapy; Humans; Infratentorial Neoplasms - diagnostic imaging; Infratentorial Neoplasms - genetics; Infratentorial Neoplasms - pathology; Infratentorial Neoplasms - therapy; Isocitrate Dehydrogenase - genetics; Magnetic Resonance Imaging; Male; Neuroectodermal Tumors, Primitive, Peripheral - diagnostic imaging; Neuroectodermal Tumors, Primitive, Peripheral - secondary; Spinal Neoplasms - diagnostic imaging; Spinal Neoplasms - secondary; Thoracic Vertebrae - diagnostic imaging
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.07.142

Glioblastoma multiforme (GBM) is a rapid-growing central nervous system neoplasm. We report a case of GBM with extensive intramedullary lumbar drop metastasis and highly unusual osseous spine metastasis from a primary infratentorial GBM occurring 10 years after the initial diagnosis, which to our knowledge has not been described previously. This 37-year-old man presented with new-onset headaches of increasing severity. Brain magnetic resonance imaging (MRI) demonstrated a heterogeneously enhancing mass in the left superior temporal lobe with adjacent edema. The lesion was initially biopsied in December 2006 and diagnosed as GBM (World Health Organization grade IV) with characteristic features of a highly cellular infiltrating glial neoplasm with nuclear pleomorphism, abundant microvascular proliferation, and abundant necrosis with pseudopalisading nuclei. Ki-67 immunostaining revealed that 15%-20% tumor cell nuclei were positive, indicating a high proliferative index. Histologically, this neoplasm demonstrated characteristic "cell wrapping." Immunoreactivity was variably but strongly positive for glial fibrillary acidic protein in neoplastic cells. In 2018, additional MRI revealed disease throughout the spine and bone biopsy of the thoracic spine showed the same glial neoplasm with primitive neuroectodermal tumor-like components (GBM-PNET). This case is meant to highlight that, although rare, infratentorial GBM-PNET has a higher frequency of isocitrate dehydrogenase 1 (IDH1) mutation and may metastasize to the spine years after the initial diagnosis despite the likely better prognosis.