Extracranial metastases of anaplastic cerebral gliomas

Seven cases are reported of anaplastic cerebral gliomas with metastases outside the neuraxis, seen among about 1500 gliomas. There were two children with anaplastic ependymomas, one adult with oligodendroglioma, and four young to middle-aged adults with astrocytomas grade III and IV. All patients had one or more craniotomies, and four had radiotherapy prior to the appearance of distant tumour deposits. The survival times ranged from 7 to 31 months in cases with gliomas grade II, and from 8 to 18 months with high grade astrocytomas. All seven tumours showed invasion of the meninges, ventricular walls, or both, and in four cases they transgressed the dura and surrounding bone or soft tissues. In six autopsy cases there was widespread dissemination of gliomas through the CSF pathways. Distant metastases involved regional or distant lymph nodes in six patients, the lungs in two, and the vertebrae, pleura, liver, or mediastinum in one patient each. The possible pathways for distant spread or intracranial gliomas and the factors which are considered responsible are briefly discussed.