Glioblastoma Multiforme in Skin: A Report of 2 Cases and Review of the Literature

Abstract

Despite an aggressive clinical course, glioblastoma multiforme (GBM) rarely develops extracranial metastasis, with only 6 cases of skin involvement reported in the literature. We report 2 cases of GBM that spread to the scalp. Both patients presented with a firm nodule adjacent to their original craniotomy site. Histologic examination revealed highly anaplastic tumor cells invading the subcutaneous tissues. Immunohistochemistry was positive for vimentin, S-100, and glial fibrillary acidic protein in the malignant cells. Although it is possible that these cases represent true metastatic GBM, the close proximity of the nodules to suture lines suggests extension of GBM to the skin through surgical sites or seeding of tumor cells. It is important to have an accurate clinical history when evaluating scalp nodules in patients with GBM, so that a diagnosis of GBM is not overlooked.

Extracranial metastasis of gliobastoma: Three illustrative cases and current review of the molecular pathology and management strategies

“…Mentrikoski et al (12) proposed that another reason primary brain tumors rarely metastasize outside of the CNS is the lack of extracellular matrix protein. In other organs, tumors metastasize by first invading through connective tissue, basement membranes and blood vessels.…”

“…Another theory suggest that there are unique barriers in the brain that prevent hematogenous and lymphatic spread, including the dura and the thickened basement membrane of the blood vessels. As a result, most cases of metastasis are considered to occur following craniotomy or intraventricular shunt placement, during which time tumor cells gain access to the blood stream through defects in the meningeal and parenchymal blood vessels that are created from such manipulation (12). Stereotactic biopsies may also cause disease spread, most likely through seeding of tumor cells during the invasive procedure (1,13,14).…”

Skin metastases of glioblastoma in the absence of intracranial progression are associated with a shift towards a mesenchymal immunophenotype: report of two cases

“…Extra-neural spread is exceedingly rare, and usually develops at the time of intracranial progression following a surgical procedure (2)(3)(4). Less frequently, metastases are a consequence of spontaneous tumour trans-dural extension or haematogenous spread.…”

Mecanismos de reparo de DNA envolvidos com lesões induzidas por agente alquilante (Nimustina) em células humanas e sua associação com a resistência de gliomas.

“…Essas características elegem o tratamento de GBM como o menos bem sucedido entre os tumores sólidos. Embora metástases para fora do sistema nervoso central sejam incomuns, alguns casos podem ser encontrados na literatura (GUO et al, 2012;MENTRIKOSKI et al, 2008).…”

“…Essas características elegem o tratamento de GBM como o menos bem sucedido entre os tumores sólidos. Embora metástases para fora do sistema nervoso central sejam incomuns, alguns casos podem ser encontrados na literatura (GUO et al, 2012;MENTRIKOSKI et al, 2008).Nos tecidos tumorais de gliomas obtidos após ressecção cirúrgica, encontra-se não somente células tumorais, como também uma quantidade considerável de células não transformadas. Estas podem ser astrócitos, células endoteliais, linfócitos e, em sua maioria, macrófagos.…”