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Ascending central nervous spreading of a spinal astrocytoma
D Claus1, E Sieber, A Engelhardt
1Department of Neurology, University of Erlangen-Nuremberg, Germany.
Abstract:
A 43-year-old man died from the complications of astrocytoma metastasis. He first noticed symptoms of a lumbar disc prolapse in 1979. In 1987 a pilocytic astrocytoma (grade I) of the spinal cauda was removed. In 1989 a tumor recidivation at the same site was partially removed. Histology showed a grade II astrocytoma. Two months later the patient developed symptoms of increased intracerebral pressure. CSF cytology showed polymorphic giant tumor cells with hyperchromatic nuclei and a glioblastoma of the cerebral ventricles was diagnosed. The patient died from cardiovascular complications. The post-mortem investigation revealed an astrocytoma of the conus medullaris with an anaplastic ventral area (grade IV). This area was inaccessible to the biopsy. It is believed that tumor metastases from anaplastic parts spread along the spinal cord and brainstem and finally invaded the brain and cerebral ventricles.
Insights
A patient with spinal astrocytoma experienced tumor progression, leading to brain metastasis and death. This case highlights the aggressive nature of high-grade astrocytoma and its potential for widespread dissemination.
Area of Science:
- Neuro-oncology
- Spinal Cord Oncology
- Neuropathology
Background:
- Astrocytomas are primary brain tumors arising from astrocytes.
- Spinal astrocytomas, though rare, can exhibit variable grades and prognoses.
- Metastasis of spinal tumors to the brain is an uncommon but severe complication.
Observation:
- A 43-year-old male initially presented with symptoms suggestive of lumbar disc prolapse.
- He underwent surgery for a spinal pilocytic astrocytoma (grade I), followed by recurrence as a grade II astrocytoma.
- The patient later developed symptoms of increased intracranial pressure, with cerebrospinal fluid cytology revealing glioblastoma cells.
Findings:
- A glioblastoma of the cerebral ventricles was diagnosed, and the patient succumbed to cardiovascular complications.
- Post-mortem examination revealed an anaplastic astrocytoma (grade IV) at the conus medullaris, inaccessible during life.
- Evidence suggests tumor metastases from the anaplastic spinal component spread via the cerebrospinal fluid pathways to the brain.
Implications:
- This case underscores the potential for spinal astrocytomas to dedifferentiate and metastasize aggressively.
- It highlights the diagnostic challenges in cases with primary spinal tumors and secondary intracranial spread.
- Understanding the metastatic pathways of spinal astrocytomas is crucial for improving patient outcomes and treatment strategies.