Elsevier

World Neurosurgery

Volume 90, June 2016, Pages 698.e7-698.e11
World Neurosurgery

Case Report
Extensive Therapies for Extraneural Metastases from Glioblastoma, as Confirmed with the OncoScan Assay

https://doi.org/10.1016/j.wneu.2016.01.074Get rights and content

Background

The diagnosis of extraneural metastasis from glioblastoma is usually based on the histopathology and immunohistochemical staining of a tumor specimen. Information regarding the molecular features of glioblastoma and optimal treatment strategies for extraneural metastasis is limited.

Case Description

A 58-year-old woman with a glioblastoma located in the left temporal lobe underwent resection followed by radiotherapy plus concomitant and adjuvant temozolomide. Ipsilateral cervical lymph node tumors were treated 29 months later with supraomohyoid neck dissection and temozolomide. The diagnosis of lymph node metastases from glioblastoma was confirmed with an OncoScan assay and pathologic analysis. The brain and lymph node tumors had identical genotypes: C228T-mutated TERT promoter, wild-type IDH1, wild-type IDH2, wild-type TP53, EGFR amplification, and unmethylated MGMT promoter. Subsequently, multiple bone metastases were detected and treated with CyberKnife radiosurgery. Widespread extraneural metastases were detected 49 months after the initial diagnosis, and the patient underwent chemotherapy with cisplatin and semustine. There was no evidence of intracranial relapse until death, which occurred 5 months after chemotherapy.

Conclusions

Similar to carcinomas, glioblastomas can spread via the lymphatic route. Extensive therapies for extraneural metastases from glioblastoma can alleviate discomfort and prolong survival, especially in patients without intracranial relapse.

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.

Section snippets

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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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.

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