Spinal Cord Glioblastoma Multiforme with Intracranial Dissemination

Abstract

A case of spinal cord glioblastoma multiforme with intracranial dissemination is reported. A 23-year -old female was admitted to a local hospital complaining of lumbago. Myelography revealed an in tramedullary thoracic tumor. The tumor was partially removed through a laminectomy at Th 11-L1. The histological diagnosis was glioblastoma multiforme, and focal irradiation (total 50 Gy) was given. Eight months after the operation, symptoms of increased intracranial pressure appeared. Computed tomographic (CT) scans showed marked hydrocephalus, and multiple tumors at anterior horns of bilateral lateral ventricles. A ventriculoperitoneal shunt and an Ommaya reservoir into the left lateral ventricle were emplaced. Three months later, she was transferred to our hospital. CT scans showed enhanced lesions in the fourth ventricle, anterior horn of the left lateral ventricle, sep tum pellucidum, and pituitary gland. Suboccipital craniectomy was performed, and the mass around the fourth ventricle was partially removed. Histological examination of the tumor specimens showed glioblastoma multiforme. Postoperatively, she received whole brain irradiation (total 50 Gy), and intrathecal injection of β-interferon via the Ommaya reservoir. However, she died of respira tory insufficiency. It is considered that the spinal cord glioblastoma multiforme disseminated into the intracranial space.

Intracranial Dissemination from Spinal Cord Anaplastic Astrocytoma

“…Intracranial seeding of spinal cord glioma may occur due to dissemination of the tumor into the spinal subarachnoid space and subsequent intracranial spread into the cerebral subarachnoid space or brain parenchyma 1,2,[7][8][9] . In addition, there is a possibility that a spinal intramedullary tumor may grow directly into the cranial cavity in an exophytic manner.…”

“…This possible mechanism can be also applicable to our case. Surgical manipulation of a spinal cord anaplastic astrocytoma may facilitate tumor cell seeding to the subarachnoid space, resulting in intracranial dissemination 1,2,[7][8][9] . Also, previous studies show increasing values of Ki-67/MIB-1 labeling index correlates with increasing grade of malignancy and proliferation 4,5) .…”

Glioblastoma primário de cone medula: relato de caso

“…Apenas 0,2 a 1,5% dos ast rocitomas medulares são glioblastomas 5 , 7 , 8 . Em 25% dos casos a lesão é secundária a um tumor primário cere b r a l 4 . Admite-se que o glioblastoma resulte, após um período de tempo variável mas u s u a lmente curto, de uma anaplasia rapidamente progressiva num astrocitoma 9 .…”

“…Ocasionalmente, estes tumores podem ser encontrados no tronco cerebral e, menos fre q ü e n t e m e nte, na medula espinhal 3 . A localização no cone medular é considerada muito rara, e existem poucos casos escritos na literatura [4][5][6] . D e s c revemos um caso de glioblastoma primário de cone medular em um paciente operado com a hipótese inicial de ependimoma, e que posteriormente, através do exame histo-patológico, foi evidenciado ser um glioblastoma.…”

Primary glioblastoma multiforme of the conus medullaris with leptomeningeal metastasis

“…Kaley and colleagues addressed the use of adjuvant temozolomide or bevacizumab (in 8 and 6 patients, respectively) and showed clinical and radiological improvement with both agents [6]. Survival to 26 months has also been shown with the use of intrathecal β-interferon in addition to radiotherapy [2]. However, other studies have failed to identify adjuvant chemotherapy as a prognostic factor in spinal GBM [9,13], probably owing to the small size and retrospective nature of all of the studies.…”