Elsevier

World Neurosurgery

Volume 73, Issue 6, June 2010, Pages 719-721
World Neurosurgery

Peer-Review Report
Metastatic Gliosarcoma Mass Extension to a Donor Fascia Lata Graft Harvest Site by Tumor Cell Contamination

https://doi.org/10.1016/j.wneu.2010.03.015Get rights and content

Background

Brain glioblastoma multiforme is a malignant and highly aggressive entity that rarely shows extracranial and extraneural invasion. In the past 70 years, only eight cases of subcutaneous metastases have been reported.

Case Description

A case of glioblastoma multiforme with extensive local cutaneous and subcutaneous involvement of previous surgical sites and a metastatic mass, which had developed in the graft donor area of the tensor fascia lata tendon used for the reconstruction of dura. According to the excisional biopsy results, the developed mass was defined as a gliosarcoma carrying the exact characteristics of the primary tumor.

Conclusions

Contaminated surgical tools and instruments can facilitate the distant spread of tumor cells. Therefore, the renewal of the surgical tools and instruments and irrigation of the surgical area after primary tumor resection is emphasized.

Introduction

Although primary brain tumors are responsible for a small number of cancer patient deaths, they dramatically reduce the quality of life because the tumors affect the patients in their prime of life. The disability and the burden of death due to primary brain neoplasms are substantial (12).

Gliosarcoma is a very rare type (1.8% to 2.4%) of glioblastoma, a malignant cancer of the central nervous system (7, 15). Previously it was defined as a glioblastoma consisting of gliomatous and sarcomatous components, but it is now defined as gliosarcoma by the World Health Organization (11).

When there is dural involvement, the defect occurs after intracranial tumor surgery. The dura is an anatomic structure that has to be restored to prevent the loss of cerebrospinal fluid, the formation of an encephalocele, and infection. This restoration can be handled with synthetic and autologous materials. This case report presents a patient with gliosarcoma who had metastasis in the grafted area due to the implantation of tensor fascia lata (TFL) for the restoration of dura defect.

Section snippets

Case Report

In 2007, a 52-year-old man was admitted to another hospital with complaints of seizure. A subtotal resection of the mass in the right frontal region was done. Histopathologic evaluation of the tumor identified it as a glioblastoma multiforme (GBM). Postoperatively the patient was treated with a total of 6000 cGy of external beam radiation but no chemotherapy. Four months after the operation, however, the patient was admitted to the emergency department of our University Hospital with complaints

Discussion

Glioblastoma multiforme diffusely infiltrates the surrounding brain matter, but does not typically invade blood vessels and rarely metastasizes outside of the central nervous system. In fact, metastasis is exceedingly rare and is present in less than 2% of cases (9). When extracranial spread of a GBM is present, it is almost always preceded by an invasive intracranial procedure, resulting in either hematogenous dissemination or direct extension of the tumor (10). During the past 70 years, more

Acknowledgments

We would like to thank Hasan Kocaeli, M.D., for his help in revising our article.

References (23)

  • E. Hsu et al.

    Bone marrow metastasis in astrocytic gliomata

    J Neurooncol

    (1998)
  • Cited by (7)

    • Secondary gliosarcoma with extra-cranial metastases: A report and review of the literature

      2013, Clinical Neurology and Neurosurgery
      Citation Excerpt :

      Han and colleagues observed a longer latency period from irradiation to diagnosis in cases of radiation-related gliosarcoma than in SGS (5.2 years and <1 year respectively) [14]. In our review of the literature, we found 44 cases of SGS (including the present one), but only 5 of these developed extra-cranial metastasis [4,8–10]. Beaumont and colleagues noted an increase in the extra-cranial metastases from gliosarcoma since the original report in 1958 [4].

    • Metastatic secondary gliosarcoma: patient series

      2023, Journal of Neurosurgery: Case Lessons
    • Implantation of Squamous Cell Carcinoma in a Free Flap Donor Site

      2020, Annals of Otology, Rhinology and Laryngology
    View all citing articles on Scopus
    View full text