IntroductionPrimary brain and CNS tumor incidence is approximately 19 per 100,000 individuals per year in the United States compared with seven per 100,000 individuals worldwide. 1,2 Worldwide this accounts for 2% of all primary tumors and 7% of years of life lost from cancer before the age of 70 years. 1,2 Glioblastoma multiforme (GBM) is also the most aggressive brain tumor with poor prognosis; patients with GBM have a median survival time of about 14 months. [3][4][5][6][7][8][9][10] GBM metastases outside the CNS are rare, so therapeutic experience with these types of tumors is limited. 11-15 Normally the brain is immunologically and anatomically separated from the body by the blood brain barrier. Herein, we present the cases of three patients with GBM with extra-CNS metastasis. The variety of metastasis locations demonstrated in these cases helps to illustrate the various mechanism and corresponding risk factors that allow GBM to escape the CNS. Case ReportsPatient 1. A 51-year-old man presented with a general seizure. Magnetic resonance imaging (MRI) revealed a lesion in the left parieto-occipital lobe (Figs 1A and 1B). Coronal T1-weighted postcontrast ( Fig 1A) and axial T2-weighted cranial MRI (Fig 1B) demonstrated an enhancing left parietal mass involving small venules from the superior sagittal sinus (Figs 1A and 1B, arrows). The patient was diagnosed with a mixed diffuse glioma and underwent subtotal resection of the tumor and postoperative radiochemotherapy. The tumor progressed, and 5 years after diagnosis, the patient underwent contrast-enhanced fluorescence imaging-guided tumor reresection with a subsequent diagnosis of GBM. Two years later, follow-up MRI revealed recurrent tumor. After completing radiochemotherapy, the patient was hospitalized for progressive dyspnea. Chest X-ray revealed a pleural effusion requiring thoracic drainage. Axial contrastenhanced computed tomography demonstrated an ill-defined 4-cm mass in the left lower lung lobe (Fig 1C, arrow) and pleural metastases (Figs 1C and 1E, arrowheads) with infiltration of the chest wall and destruction of a ventrolateral left rib (Fig 1E, asterisks).The pleural lesion was biopsied, and histologic examination of the biopsy sample (Fig 1D, hematoxylin and eosin staining, ϫ200 original magnification) revealed a malignant astrocytic glioma.The patient underwent additional radiochemotherapy with concomitant temozolomide. He completed radiotherapy but died 4 weeks later.Patient 2. A 24-year-old man who had undergone resection of a left temporal GBM involving the greater wing of the sphenoid bone with invasion of the middle cranial fossa at an outside facility presented with anxiety and headaches. Postoperative MRI revealed on axial T1w postcontrast images a dural thickening and extraconal or-

Calcifying pseudoneoplasms are rare benign lesions of the CNS of yet unknown origin. Because of the increasing number of reports, this clinical entity should be taken into consideration in the differential diagnosis of intracranial and intraspinal calcified lesions.

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IntroductionThe dorsal root ganglion is a rare manifestation of metastatic spread. We report what we believe to be the first case of metastasis of a pulmonary adenocarcinoma to the lumbar dorsal root ganglion. Only four descriptions for different primary tumors spreading to the dorsal root ganglion have been described in the literature so far.Case presentationA 70-year-old Caucasian woman with a four-month history of left-sided lumbar radiculopathy was admitted to our department under the assumption of a herniated lumbar disc. Her past medical history included a pulmonary adenocarcinoma and invasive ductal breast cancer.Lumbar magnetic resonance imaging revealed a space-occupying mass in her left neuroforamen L3-L4 with compression of her L3 nerve root. Neurinoma was taken into account as a differential diagnosis, although not considered typical. Surgery revealed a metastasis of pulmonary adenocarcinoma to her dorsal root ganglion.ConclusionsDorsal root ganglion metastases seem to be extremely rare and can mimic primary local nerve sheath tumors. Therefore, they usually present as incidental findings. Resection should be performed strictly under intraoperative monitoring as tumor spread between the nerve fibers is commonly observed. Metastases should be taken into account in spinal nerve tumors involving the dorsal root ganglion, especially in patients harboring known malignant diseases. The low incidence means that no clear treatment advice can be given. Resection is possible under intraoperative monitoring and relieves neurological symptoms.