Case of metastatic glioblastoma with primitive neuronal component to the lung

Tamai, Sho; Kinoshita, Masashi; Sabit, Hemragul; Furuta, Takeshi; Miyashita, Katsuyoshi; Yoshimura, Kaori; Homma, Taku; Harada, Kenichi; Nakada, Mitsutoshi

doi:10.1111/neup.12553

Cited by 17 publications

(15 citation statements)

References 8 publications

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“…Goodwin and colleagues reviewed 28 cases of GBM metastases to the vertebra, with a mean age at presentation of 38.4 years and an average overall survival of 26 months, of which seven patients received surgery for vertebral metastases (34). After a systematic search on Medline, Embase, and Google Scholar, we retrieved 25 cases of GBM-PNC with extracranial metastases from 14 reports (Table 2) (7,16,17,22,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). CSF dissemination occurred in 88% (22/25) of the patients, whereas only 4 patients (16%) suffered bone metastases.…”

Section: Discussionmentioning

confidence: 99%

A Rare Manifestation of a Presumed Non-Osteophilic Brain Neoplasm: Extensive Axial Skeletal Metastases From Glioblastoma With Primitive Neuronal Components

et al. 2021

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BackgroundGlioblastoma multiforme (GBM) is the most common malignant tumor of the central nervous system. GBM with primitive neuronal component (GBM-PNC) is an aggressive variant identified in 0.5% of GBMs. Extracranial metastasis from GBM-PNC is a rare and challenging situation.MethodsA special case of early-onset GBM with systemic bone metastasis was enrolled. Clinical data, including patient characteristics, disease course, and serial radiological images were retrieved and analyzed. Tumor tissues were obtained by surgical resections and were made into formalin-fixed paraffin-embedded sections. Histopathological examinations and genetic testing were performed for both the primary and metastatic tumor specimens.ResultsA 20-year-old man suffered from GBM with acute intratumoral hemorrhage of the left temporal lobe. He was treated by gross total resection and chemoradiotherapy following the Stupp protocol. Seven months later, he returned with a five-week history of progressive neck pain and unsteady gait. The radiographic examinations identified vertebral collapse at C4 and C6. Similar osteolytic lesions were also observed at the thoracolumbar spine, pelvic, and left femur. Anterior spondylectomy of C4 and C6 was performed. The resected vertebral bodies were infiltrated with greyish, soft, and ill-defined tumor tissue. One month later, he developed mechanical low-back pain and paraplegia caused by thoracolumbar metastases. Another spine surgery was performed, including T10 total en-bloc spondylectomy, T7-9, L2-3, and L5-S1 laminectomy. After the operation, the patient’s neurological function and spinal stability remained stable. However, he finally succumbed to the rapidly increased tumor burden and died 15 months from onset because of cachexia and multiple organ failure. In addition to typical GBM morphology, the histological examinations identified monomorphic small-round cells with positive immunohistochemical staining of synaptophysin and CD99, indicating the coexistence of PNC. The next-generation sequencing detected pathogenic mutations in TP53 and DNMT3A. Based on above findings, a confirmed diagnosis of systemic metastases from GBM-PNC (IDH-wild type, WHO grade IV) was made.ConclusionsThe present case highlights the occurrence and severity of extensive axial skeletal metastases from GBM-PNC. This rare variant of GBM requires aggressive multimodal treatment including surgery and chemoradiotherapy targeting PNC. The pathological screening of PNC is recommended in patients with early-onset GBM and intratumoral hemorrhage. Surgery for spinal metastasis is appropriate in patients with chemoradioresistance and relatively good general status, with the objectives of restoring spinal stability and relieving spinal cord compression.

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Section: Discussionmentioning

confidence: 99%

A Rare Manifestation of a Presumed Non-Osteophilic Brain Neoplasm: Extensive Axial Skeletal Metastases From Glioblastoma With Primitive Neuronal Components

et al. 2021

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“…ENM arising from glioblastoma with a primitive neuronal component has been reported recently [21, 22]. However, case 1 of our series is, to the best of our knowledge, the first reported case with manifestation in the parotid gland.…”

Section: Discussionmentioning

confidence: 57%

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

2021

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Introduction: Extraneural/-cranial metastases (ENM) of primary central nervous system (CNS) tumors are rare and may be diagnostically challenging. We describe the cytomorphological and pertinent clinical features of ENM in a case series assessed by fine-needle aspiration (FNA). A search of the laboratory information systems of 2 tertiary care centers in Toronto (2000–2015) was performed. Cases with direct extracranial/-spinal extension of CNS neoplasms were excluded. Microscopic slides of FNA and surgical specimens were reviewed. Demographic and clinicopathological data were retrieved. Case Presentation: Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22–56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area. Discussion/Conclusion: ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.

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“…However, GBM‐PNC has a high tendency to spinal metastasis and cerebrospinal fluid dissemination 12,13 . Although spinal metastasis is common in patients with GBM‐PNC, some other extracranial metastases to lung and bone have been reported 13,14 …”

Section: Discussionmentioning

confidence: 99%

“…12,13 Although spinal metastasis is common in patients with GBM-PNC, some other extracranial metastases to lung and bone have been reported. 13,14 Temozolomide is the treatment of GBM, while platinum-based chemotherapy is effective on PNETs. However, the treatment of GBM-PNC is still a challenge due to few available data on therapeutic approaches.…”

Section: Discussionmentioning

confidence: 99%

A review of glioblastoma tumors with primitive neuronal component and a case report of a patient with this uncommon tumor at a rare location

Shayganfar

Ebrahimian

Mahzouni

et al. 2020

Clinical Case Reports

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Case of metastatic glioblastoma with primitive neuronal component to the lung

Cited by 17 publications

References 8 publications

A Rare Manifestation of a Presumed Non-Osteophilic Brain Neoplasm: Extensive Axial Skeletal Metastases From Glioblastoma With Primitive Neuronal Components

A Rare Manifestation of a Presumed Non-Osteophilic Brain Neoplasm: Extensive Axial Skeletal Metastases From Glioblastoma With Primitive Neuronal Components

Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update

A review of glioblastoma tumors with primitive neuronal component and a case report of a patient with this uncommon tumor at a rare location

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