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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(01): 47-53
DOI: 10.1055/s-0036-1597571
Case Report | Relato de Caso
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Subcutaneous Dissemination in Highly Aggressive Intracranial Glioblastoma: Case Report and Literature Review

Disseminação subcutânea de glioblastoma intracraniano altamente agressivo: caso clínico e revisão da literatura
Pedro Ribeiro da Cunha
1   Serviço de Neurocirurgia, Centro Hospitalar Universitário de Coimbra, Coimbra, Coimbra, Portugal
,
Gonçalo Costa
1   Serviço de Neurocirurgia, Centro Hospitalar Universitário de Coimbra, Coimbra, Coimbra, Portugal
,
Marcos Barbosa
1   Serviço de Neurocirurgia, Centro Hospitalar Universitário de Coimbra, Coimbra, Coimbra, Portugal
› Author Affiliations
Further Information

Publication History

09 September 2016

09 November 2016

Publication Date:
30 December 2016 (online)

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Abstract

Glioblastoma (GBM) is a highly invasive and incurable primary central nervous system (CNS) tumor. Despite its aggressive behavior, extracranial metastases are rare, with an estimated incidence of less than 2%. In our literature review, we found only 21 reported cases of skin and soft tissue dissemination. We report a case of an early (two and a half months) postoperative skin and muscle flap-associated dissemination of a temporal glioblastoma. The particular aspect of this case, besides its rarity, is that the clinical presentation, the image reports and even the surgical findings were always in favor of a postoperative subdural empyema and epicranial abscesses. The diagnosis of soft tissue dissemination was only possible after negative microbiological cultures and histopathological confirmation of muscle and skin invasion by the tumor. This case illustrates the rare but potential risk of myocutaneous flap tumor dissemination through the durotomy/craniotomy site that can mimic a much more common, post-surgical infection.

Resumo

O glioblastoma é um tumor do sistema nervoso central extremamente invasivo e incurável. Apesar do comportamento agressivo desses tumores, a metastização extracraniana é rara, apresentando uma incidência inferior a 2%. A nossa revisão da literatura revelou apenas 21 casos descritos de disseminação de glioblastoma para a pele e tecidos moles. Nós descrevemos um caso de disseminação precoce de um glioblastoma temporal para o retalho miocutâneo associado à cirurgia, cerca de 2 meses e meio após a intervenção. Além da raridade, este caso é peculiar, uma vez que tanto a forma de apresentação clínica quanto a descrição imagiológica e os achados intraoperatórios foram sempre muito sugestivos de um empiema subdural e de abcessos epicranianos. O diagnóstico definitivo de disseminação tumoral para os tecidos moles apenas foi possível após o resultado negativo das culturas microbiológicas e a confirmação histológica de invasão do músculo e da pele pelo tumor. Este caso ilustra o raro, mas potencial risco de disseminação tumoral de um glioblastoma através do retalho miocutâneo de acesso cirúrgico e do local de craniotomia/durotomia, que se pode facilmente confundir com uma situação mais frequente de infecção após cirurgia.

Keywords

soft tissue dissemination - glioblastoma - subdural empyema - brain abscess

Palavras-chave

disseminação nos tecidos moles - glioblastoma - empiema subdural - abcesso cerebral
 

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