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CASE REPORT
Year : 2016  |  Volume : 11  |  Issue : 4  |  Page : 452

A case of symptomatic synchronous cervical and cerebellar metastasis after resection of thoracal metastasis from temporal glioblastoma multiforme without any local recurrence


Department of Neurosurgery, School of Medicine, Necmettin Erbakan University, Konya, Turkey

Date of Web Publication7-Jul-2016

Correspondence Address:
Dr. Yasar Karatas
Department of Neurosurgery, School of Medicine, Necmettin Erbakan University, Konya 42080
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1793-5482.145047

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  Abstract 

Glioblastoma multiforme (GBM) is the most common and the most malignant primary intracranial tumor in adults and it is usually occurs between the age of 40 and 60 years. It is local invasive and recurrent tumor and hence that has a poor prognosis. However, recent advances in tumor surgery, irradiation and chemotherapeutic agent permit long survival and metastasis which is symptomatic. Previously studies reported spinal metastasis, but we report a first case of synchronous symptomatic cerebellar and cervical spinal metastasis after resection of symptomatic thoracic spinal metastasis from temporal GBM without any recurrence of excision areas.

Keywords: Glioblastoma multiforme, metastasis, prolong survival, surgical excision


How to cite this article:
Karatas Y, Cengiz SL, Ustun ME. A case of symptomatic synchronous cervical and cerebellar metastasis after resection of thoracal metastasis from temporal glioblastoma multiforme without any local recurrence. Asian J Neurosurg 2016;11:452

How to cite this URL:
Karatas Y, Cengiz SL, Ustun ME. A case of symptomatic synchronous cervical and cerebellar metastasis after resection of thoracal metastasis from temporal glioblastoma multiforme without any local recurrence. Asian J Neurosurg [serial online] 2016 [cited 2019 Mar 19];11:452. Available from: http://www.asianjns.org/text.asp?2016/11/4/452/145047


  Introduction Top


Glioblastoma multiforme (GBM) was first described by Rudolph Virchow in 1863.[1] Temporal lobe is the most frequent tumor localization in cerebral hemispheres, but cerebellar localization is very rare.[2] Standard therapy is surgical resection and chemo-radiotherapy for GBM. Local control of the tumor is the major problem and recurrence usually occurs at the radiotherapy zone.[3] Median survival of the patient, diagnosed GBM, is 6 and 12 months.[4] At 3 years survival, after the first operation for GBM defined as a long survival and occur about 2-3% of the patient. This poor prognosis is due to high proliferation rates and extensive invasion into the brain tissue.[5],[6] Hence that the symptomatic metastasis of the GBM seems very rarely.


  Case Report Top


The present case report is about a 55-year-old male patient who was referred to our department for management of headache persisted for a few months. Neurological examination showed that facial paralysis. Magnetic resonance imaging (MRI) of the brain revealed the presence of a mass in the right temporal lobe about 5 cm × 4 cm × 6 cm [Figure 1]. A right frontotemporal craniotomy was performed. Total removal of the tumor was performed. The histopathological study yielded a diagnosis of GBM [Figure 2]. Adjuvant radiotheraphy and chemotherapy was performed. The patient presented with weakness of both lower extremities after 2 years of operation. Neurological examination revealed spastic paraparesis (2/5) and sensory impairment below T3 and bilateral positive Babinski response. There was no recurrence on brain MRI. Contrast enhanced thoracal spine MRI showed intramedullary lesion at T4-T7 levels [Figure 3]. Total tumor removal was performed through thoracal 4-7 total laminectomy. Histopathological examination of the specimen revealed GBM. Chemo-radiotherapy was performed again. Physiotherapy proposed after 1 month of operation. There was an improvement on paraparezis after 6 months. Then 5 years later of the first operation, the patient refer to our clinic for progressive quadriparesis, headache, nausea and vomiting. Both lower and upper extremities deep tendon reflexes were hyperactive. Brain and cervical MRI showed cerebellar and cervical mass at C5-6 level [Figure 4]. Both two tumors removal was performed totally. Histopathological study revealed GBM. The patient died due to pulmonary embolism while medical therapy was going on.
Figure 1: Preoperative axial MRI showed right temporal glioblastoma multiforme

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Figure 2: Photomicrograph of the tumor demonstrating regions of necrosis, microvascular proliferation and pleomorphism (original magnification, x100; haematoxylin-eosin stain)

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Figure 3: Contrast enhanced thoracal spine MRI showed GBM metastasis

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Figure 4: Brain and cervical MRI showed cerebellar and cervical metastatic mass of GBM

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  Discussion Top


Metastasis of the GBM was first described by Davis in 1928.[7] The metastasis of the primary central nervous system tumor is very rarely observed. Although GBM metastasis have been reported in autopsy series, it is very rare that come across symptomatic spinal metastasis of GBM.[8] The clinical and autopsy series of GBM metastasis show different frequency. Stark et al. in their study havereported 3 cases in their 267 patient, diagnosed GBM. The incidence of spinal metastasis has been reported in the range of 20-40% in autopsy series. This is associated with short survival of patient.[1],[9] Our patient gave symptoms because of his long survival. The most common localization of spinal metastasis is lower thoracal, upper lumbar and lumbo-sacral junction.[10] Our case has thoracal metastasis first and then cervical and cerebellar metastasis has been seen at the same time. This is the first case has a both cervical and cerebellar GBM metastasis without local recurrence of intracranial and spinal GBM. The symptoms of glioblastomas associated with the location of the mass and its rate of proliferation. Glioblastomas usually present with generalized symptoms that are caused by increased intracranial pressure. The most common clinical presentations are headache, seizure, mental disturbance, nausea and vomiting. Headache is the most frequent initial symptom.[11] Our patient presented with headache due to increased intracranial pressure and facial paralysis associated with temporal location. The clinical signs of the spinal metastasis are sensory symptoms, radicular pain, back pain, paraparesis, quadriparezis, paraplegia, bowel and bladder and sexual disorders.[12] The most common symptom is paraparesis reported by Schwaninger et al. in the year 1992 and usually seen in the young patient.[8] Our patient was 55 years old and has paraparesis when the spinal thoracal metastasis was diagnosed. The patient with spinal metastasis of GBM has 1 year survival and die in a few months after became symptomatic. However, our case live 5 years after spinal metastasis has diagnosed.[13]


  Conclusion Top


As a result, GBM can spread of cerebrospinal pathways and physicians must be careful about the symptoms. Moreover, it is important that total excision is associated with long survival and symptomatic metastasis can be seen in the patient with long survival.


  Acknowledgments Top


A lot of thanks to my colleagues and dear editors.

 
  References Top

1.
Stark AM, Nabavi A, Mehdorn HM, Blömer U. Glioblastoma multiforme-report of 267 cases treated at a single institution. Surg Neurol 2005;63:162-9.  Back to cited text no. 1
    
2.
Kleihues P, Cavenee WK. World Health Organisation Classification of Tumors. Pathology and Genetics of Tumors of the Nervous System. Lyon, France: IARC Press; 2000.  Back to cited text no. 2
    
3.
Lee SW, Fraass BA, Marsh LH, Herbort K, Gebarski SS, Martel MK, et al. Patterns of failure following high-dose 3-D conformal radiotherapy for high-grade astrocytomas: A quantitative dosimetric study. Int J Radiat Oncol Biol Phys 1999;43:79-88.  Back to cited text no. 3
    
4.
Reni M, Cozzarini C, Ferreri AJ, Ceresoli GL, Galli L, Bianchi A, et al. A retrospective analysis of postradiation chemotherapy in 133 patients with glioblastoma multiforme. Cancer Invest 2000;18:510-5.  Back to cited text no. 4
    
5.
Burton EC, Lamborn KR, Forsyth P, Scott J, O'Campo J, Uyehara-Lock J, et al. Aberrant p53, mdm2, and proliferation differ in glioblastomas from long-term compared with typical survivors. Clin Cancer Res 2002;8:180-7.  Back to cited text no. 5
    
6.
Scott JN, Rewcastle NB, Brasher PM, Fulton D, Hagen NA, MacKinnon JA, et al. Long-term glioblastoma multiforme survivors: A population-based study. Can J Neurol Sci 1998;25:197-201.  Back to cited text no. 6
    
7.
Ng WH, Yeo TT, Kaye AH. Spinal and extracranial metastatic dissemination of malignant glioma. J Clin Neurosci 2005;12:379-82.  Back to cited text no. 7
    
8.
Schwaninger M, Patt S, Henningsen P, Schmidt D. Spinal canal metastases: A late complication of glioblastoma. J Neurooncol 1992;12:93-8.  Back to cited text no. 8
    
9.
Hübner F, Braun V, Richter HP. Case reports of symptomatic metastases in four patients with primary intracranial gliomas. Acta Neurochir (Wien) 2001;143:25-9.  Back to cited text no. 9
    
10.
Karaca M, Andrieu MN, Hicsonmez A, Guney Y, Kurtman C. Cases of glioblastoma multiforme metastasizing to spinal cord. Neurol India 2006;54:428-30.  Back to cited text no. 10
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11.
Sánchez-Herrera F, Castro-Sierra E, Gordillo-Domínguez LF, Vaca-Ruiz MA, Santana-Montero B, Perezpeña-Diazconti M, et al. Glioblastoma multiforme in children: Experience at Hospital Infantil de Mexico Federico Gomez. Childs Nerv Syst 2009;25:551-7.  Back to cited text no. 11
    
12.
Buhl R, Barth H, Hugo HH, Hutzelmann A, Mehdorn HM. Spinal drop metastases in recurrent glioblastoma multiforme. Acta Neurochir (Wien) 1998;140:1001-5  Back to cited text no. 12
    
13.
Vertosick FT Jr, Selker RG. Brain stem and spinal metastases of supratentorial glioblastoma multiforme: A clinical series. Neurosurgery 1990;27:516-21.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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  Introduction
  Case Report
  Discussion
  Conclusion
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   References
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