[An autopsy case of glioblastoma with diffuse leptomeningeal spread that was difficult to diagnose before death]

The patient was a male in his 50s. He had been aware of headache since the end of April, X year, and was admitted to the Neurosurgery Department of X Hospital in early May; however, his headache and posterior neck pain worsened. He was discharged from the previous hospital and admitted to this hospital in late May. His consciousness was clear, and there were no abnormalities in his cranial nerves or limb motor systems. Tendon reflexes were normal and Babinski's sign was negative. He complained of posterior neck pain and remained in bed all day with his neck flexed backward. Head MRI showed a high fluid-attenuated inversion recovery (FLAIR) signal, high diffusion-weighted imaging (DWI) signal, and low T₂* signal around the inferior horn of left lateral ventricle, and contrast-enhanced MRI showed a diffuse contrast effect on the cerebral surface, brainstem, and spinal cord soft membrane. Cerebrospinal fluid (CSF) analysis showed 98 cells/μl (66% mononuclear cells, 34% polymorphonuclear cells), protein level of 140 ‍mg/dl, and glucose level of 32 ‍mg/dl (simultaneous blood glucose 160 ‍mg/dl); cytology was negative. Malignant lymphoma, fungal/tuberculous meningitis, meningeal carcinomatosis, and granulomatous disease were suspected; however, no abnormalities were observed. In mid-June, the patient's condition suddenly deteriorated, and he died. Autopsy revealed an epithelioid glioblastoma (isocitrate dehydrogenase [IDH]-wild-type, World Health Organization [WHO] grade IV) near the left subventricular angle, with diffuse infiltration of the glioblastoma on the cerebral surface, brainstem, and spinal cord pia mater. The patient was diagnosed with glioblastoma with diffuse leptomeningeal spread.