Vertebral collapse with quadraparesis due to metastatic gliobla multiforme: case report and review of the literature

Abstract

A case is reported of a patient rendered quadraparetic following collapse of a cervical vertebra due to neoplastic invasion by metastatic glioblastoma multiforme. The case is discussed in light of a review of the world literature regarding the clinical incidence and significance of metastasis of glial tumors. It is recommended that all patients with high grade glial tumors who complain of back pain be evaluated with plain radiographs and MRI of the spine or 99Tc bone scan. The management of pathologic spine fractures from metastatic glial tumors with accompanying spinal instability or spinal cord compression due to intracanalicular bone should aim for immediate surgical decompression and stabilization followed by involved field irradiation.

Extraneural Glioblastoma Multiforme Vertebral Metastasis

“…In all cases with surgical intervention, a combined course of radiation at levels between 5000 and 7000 cGy and chemotherapy was given in the postoperative period. 8,9,22,24,28,31–38 The most commonly employed chemotherapy agents included temozolomide, bis-chloroethylnitrosourea, and nimustine hydrochloride. 31,34,38,39 …”

“…28,34,35,37 Patients also report diffuse back pain, or diffuse discomfort and stiffness, not relieved by analgesics. 20,23,28,31–33,38 Weakening of the vertebrae as the result of metastatic inflltration also can lead to segmental instability, pathologic fracture, 31 or kyphotic deformity, leading to increased pain and/or neurologic deficit. Axial pain can occur with or without hypesthesia, radicular pain, or other peripheral neurologic symptoms.…”

Pleural and Bone Marrow Metastasis from Supratentorial Oligoastrocytoma Grade III

“…Extraneural metastasis of malignant gliomas is unusual, although the number of such cases has increased since its first description in 1928 [4][5][6]. Despite these reports, little information concerning the clinical findings, radiographic evaluation, treatment, subsequent clinical course and prognosis of extraneural glial dissemination is available.…”

“…Since false-negative results have been reported, repeating these studies at a later date should be considered if the patient's complaints are persistent. In questionable cases, or patients with bone pain or abnormal hematological profile, bone marrow biopsy may be helpful [4]. In general, the diagnosis of extraneural metastasis can be established only if the following criteria are met: (1) the clinical history must indicate a CNS tumor as the initial neoplasm; (2) the clinical manifestation of the initial neoplasm must precede the clinical manifestation of metastasis; (3) the morphological features of the primary and the metastatic lesions must be identical [6].…”

“…Malignant glioma may metastasize to the lungs, pleura, lymph nodes, bone, kidney, liver, nerve or peritoneal cavity [4][5][6]10]. Factors that promote extraneural metastasis may possibly include (1) neurosurgical procedures like craniotomy with tumor debulking and ventriculoperitoneal shunt placement, (2) extension of the tumor into the extraneural spaces through the cranial nerves and the intracranial blood vessels, (3) direct transdural tumor spread at sites unrelated to surgical intervention, (4) failure of the immune system favored by the relatively long survival, (5) proximity of the tumor to the ventricular system, (6) young age and (7) prolonged survival times [7,8].…”