Secondary glioblastoma with abdominal metastasis: Case report

Abstract

Extracranial glioblastoma (GB) metastasis is an uncommon entity, rarely described in the literature, representing 0.2% of cases of GB. Several theories have been proposed to explain the extracranial dissemination of GB, such as surgical interventions, ventriculoperitoneal shunt, and radiation therapy. We present a case of a 15-year old adolescent girl, with an initial diagnosis of low-grade glioma and later transformation to a high-grade glioma. In the final phase of the disease, the patient presented with distention and abdominal pain, secondary to peritoneal compromise of GB metastasis. The use of new therapies has increased survival times, leading to a rise in the probability of developing extracranial metastasis.

Extracranial metastases in secondary glioblastoma multiforme: a case report

“…Despite surgery on the primary lesion have been reported in association with hematogenous seeding of tumor cells [7], around 10% of the reported cases of extracranial GBM diffusion occurred without surgical intervention [3], and recent studies did not find evidence for a tumoral cells release induced by surgery [12]. If metastases from primary glioblastomas are rare, extracranial dissemination from a secondary GBM is an exception [9,13]. We performed a research in PubMed, looking for other cases of secondary GBM with extracranial metastasis, and we found seven other cases [4,9,[13][14][15][16][17], including one case of peritoneal dissemination following ventricle-peritoneal shunt (Table 1) [13].…”

“…If metastases from primary glioblastomas are rare, extracranial dissemination from a secondary GBM is an exception [9,13]. We performed a research in PubMed, looking for other cases of secondary GBM with extracranial metastasis, and we found seven other cases [4,9,[13][14][15][16][17], including one case of peritoneal dissemination following ventricle-peritoneal shunt (Table 1) [13]. Our patient is the eighth described case of this very rare occurrence, as she presented systemic metastases from secondary glioblastoma despite a prognostically favorable biomolecular pattern.…”

“…Furthermore, the progressive systemic involvement occurred without any sign of progression of the intracranial pathology, countering the hypothesis that local tumor progression is a major cause of systemic metastases [ 18 , 19 ]. Moreover, it’s known that GBM spreading plays a minor role for the clinical course and prognosis of affected patients, but this phenomenon is putatively more common than assumed as systemic metastases of the GBM are found in 6–25% of autopsies of affected patients [ 7 ] and tumoral circulant cells has been detected in 20% of GBM cases [ 13 ]. We can suppose that a longer disease progression due to an initially good histological and molecular pattern may increase the likelihood of a systemic involvement from GBM.…”

“…Nuclear accumulation of p53 in a subpopulation of ca. 1–2% Stereotactic biopsy and follow-up 24 Positivity for GFAP in 65% and p53 in 5–10% of tumor cells Surgery, followed by RT, and concomitant CT with Temozolomide 36 Lung, pulmonary lymph nodes, vertebrae, cervical muscles and epidural space Surgery on the cervical spine, followed by combined RT and CT with temozolomide 10 Taskapılıoglu et al, 2013 [ 16 ] 30 Female WHO grade III Anaplastic Oligodendroglioma Positivity for S-100 and focal GFAP expression Surgery 7 Positivity for GFAP and p53 Surgery, followed by RT and CT (7 cycles of Temozolomide) 10 Right parotid gland; right cervical, preauricular and retro auricular lymph nodes; bone (left ischium) parotidectomy and radical neck dissection 6 Granados et al, 2018 [ 13 ] 15 Female Low grade Astrocytoma Not described Ventriculoperitoneal shunt, followed by RT; subsequent stereotactic radiosurgery for a relapse 49 Not described CT with Temozolomide 0 Posterior wall of the uterus, lateral wall of the rectum, II hepatic segment, right kidney, and peritoneal layers Palliative care 1 Rodrigues et al, 2020 [ 17 ] 32 Male WHO grade III Anaplastic Astrocytoma Positivity for GFAP, mutated IDH1 (R132H) negative, Ki-67 index: 8% Stereotactic biopsy, followed by CT with Temozolomide and RT 19 Positivity for GFAP, Vimentin, S100β, SOX-2, Nestin RT, CT and palliative surgery 0 Cervical nodes, neck, ribs, thoracic spine and the scapula RT, CT and two palliative surgeries 3 Our case 29 Female WHO grade II Astrocytoma MGMT promoter methylated, IDH1-mutated; absence of 1p/19q deletion; ki-67 index: 4% Two surgeries 34 MGMT promoter methylated, IDH1-mutated; absence of 1p/19q deletion; ki-67 index: 60% Surgery, followed by RT, concomitant and adjuvant CT with Temozolomide 5 Right cervical lymph node; b...…”

Postoperative Extra-Cranial Metastasis of Glioblastoma: A Case Report

“…The median survival is about one year (7). Blood brain barrier, lack of true lymphatic system and low survival rate are considered as some reasons to explain why distant metastasis of this tumor is very rare (8). However, among all glioma tumors, glioblastoma is the most common tumor with extra-cranial metastasis (41.4 %) (9).…”