Case ReportExtensive Therapies for Extraneural Metastases from Glioblastoma, as Confirmed with the OncoScan Assay
Introduction
Extraneural metastasis from glioblastoma is rare with an estimated incidence of <2%.1, 2, 3 Several hypotheses have been proposed to explain the rarity of this phenomenon.1, 2, 3 One hypothesis is that patients with glioblastoma do not survive long enough to develop clinically detectable extraneural metastasis. Another hypothesis is that there are obstacles to extraneural dissemination, such as the blood-brain barrier and the lack of a classic lymphatic drainage system. Diagnosis of extraneural metastasis from glioblastoma is based on the morphology and immunohistochemistry of a tumor specimen, but information regarding the molecular features of glioblastoma is limited.4 Moreover, there are few reports concerning the optimal treatment approach for extraneural metastases. We present our experience of a patient with extraneural metastases from glioblastoma. We describe the treatment strategy applied and the molecular features and possible metastatic route of this tumor.
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Case Report
In December 2009, a 58-year-old, right-handed woman presented with a 1-month history of memory decline. On examination, she was neurologically normal, but a magnetic resonance imaging scan demonstrated a contrast-enhanced solid and partially cystic mass in the left temporal lobe (Figure 1A). A craniotomy was performed with gross total resection of the tumor, which was subsequently diagnosed as a glioblastoma (World Health Organization grade IV) by a senior neuropathologist. Tumor attachment to
Discussion
With improvements in diagnostic tools and patient survival, the diagnosis of extraneural metastasis from glioblastoma has increased.2 Our patient had a primary glioblastoma that had an aggressive clinical course as suggested by TERT promoter mutation, wild-type IDH, and EGFR amplification.5, 8 A recent study suggested that complete resection and temozolomide chemotherapy could abrogate the negative effect of TERT promoter mutation on prognosis.8 Our patient exhibited long-term survival after
Conclusions
Long-term survival and dural invasion may be risk factors for extraneural metastasis from glioblastoma. Our case demonstrates that glioblastoma can spread via the lymphatic route, similar to carcinomas. To alleviate discomfort and prolong survival, extensive therapies can be applied to treat extraneural metastases from glioblastoma, especially for patients without intracranial relapse.
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2017, Cancer LettersCitation Excerpt :When given access to extra neural sites, the VM-M3 tumor cells display metastasis to multiple organ systems including liver, spleen, kidneys, lungs, and brain [27]. The extraneural metastasis seen for the VM-M3 tumor cells is similar to what has been documented for human glioblastoma cells that gain access to extraneural sites [28–32]. The VM-M3 cells therefore represent an ideal model system for measuring metastatic load in a syngeneic immunocompetent host.
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2023, Journal of Neuro-Oncology
Conflict of interest statement: This study was supported by the Research Special Fund for Public Welfare Industry of Health (Grant No. 201402008) and the National Key Clinical Specialist Construction Programs of China.