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Spinal metastasis of glioblastoma multiforme: an uncommon suspect?
Theodossios A Birbilis1, Georgios K Matis, Savvas G Eleftheriadis
1Department of Neurosurgery, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
Study Design:
Case report.
Objective:
To report a case and review the literature on glioblastoma multiforme (GBM) with drop-like metastasis to the spine.
Summary Of Background Data:
GBM constitutes the most common adult malignant brain tumor with poor prognosis. Spinal metastases of this malignancy are quite rare and dissemination usually occurs late in the course of the disease. However, recent advances in cancer treatment prolongate survival and provide adequate time for these metastases to give clinical symptoms.
Methods:
We hereby present a case of a 57-year-old woman with a history of pineal GBM treated by stereotactic biopsy, chemotherapy, and radiotherapy, readmitted 38 months later due to gait disturbance, spastic paraparesis, edema of lower limbs, bilateral positive Babinski response, and loss of bladder control. A contrast-enhanced magnetic resonance imaging demonstrated an intramedullary lesion extending from C7 to T3 level. A T1 and T2 laminectomy was undertaken followed by extensive biopsy.
Results:
Histologic examination was consistent with GBM. No further treatment was given, and the patient died 2 months after the diagnosis of the spinal metastasis.
Conclusion:
Spinal metastases should be commonly suspected in patients with a history of intracranial GBM who complain about symptoms not explained by the primary lesion.Glioblastoma multiforme (GBM) was first described by Rudolph Virchow in 1863 and represents the most common and most malignant tumor of the cerebral hemispheres, usually arising between the ages of 40 and 60 years. The incidence in Europe and North America is 2 to 3 cases/100,000 per year, and 75% of the patients die within 18 months after diagnosis. It is an infiltrating malignancy that recurs locally and it may spread along compact fiber pathways such as corpus callosum, optic irradiation, anterior commisure, and fornix or via cerebrospinal fluid (CSF) pathways. However, when GBM is under apparent control, spinal metastases are clinically rarely detected. Although involvement of the spinal cord (SC) has been noted with increasing frequency in recent years, literature provides only a few well documented cases.
Insights
Glioblastoma multiforme (GBM) spinal metastases are rare but should be suspected in patients with neurological symptoms. This case highlights the importance of considering GBM spread to the spine, even after initial treatment.
Area of Science:
- Neurology
- Oncology
- Neurosurgery
Background:
- Glioblastoma multiforme (GBM) is the most common and aggressive primary brain tumor in adults, typically presenting with a poor prognosis.
- Spinal metastases from GBM are uncommon, often occurring late in the disease course, but prolonged survival due to advanced treatments can lead to symptomatic presentations.
Observation:
- A 57-year-old woman with a history of pineal GBM developed gait disturbance, spastic paraparesis, and bladder dysfunction 38 months post-treatment.
- Magnetic resonance imaging revealed an intramedullary spinal cord lesion from C7 to T3, confirmed as GBM via biopsy after laminectomy.
Findings:
- Histological examination confirmed the spinal lesion as Glioblastoma Multiforme.
- The patient succumbed to the disease two months following the diagnosis of spinal metastasis.
Implications:
- This case underscores the necessity of suspecting spinal metastases in GBM patients presenting with new neurological deficits unexplained by the primary tumor.
- Increased vigilance for GBM spinal dissemination is warranted given improving patient survival rates and the potential for late-stage complications.
