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Cent Eur Neurosurg 2009; 70(1): 39-42
DOI: 10.1055/s-2008-1080941
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Multifocal Glioblastoma with Remote Cutaneous Metastasis: A Case Report and Review of the Literature

Multifokales Glioblastoma mit entfernter Hautmetastasierung: Fallbericht und Evaluationsstudie der LiteraturG. Miliaras 1 , P. P. Tsitsopoulos 2 , S. Markoula 3 , A. Kyritsis 3 , K. S. Polyzoidis 1 , V. Malamou-Mitsi 4
  • 1Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
  • 2Department of Neurosurgery, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
  • 3Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
  • 4Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
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Publication History

Publication Date:
03 February 2009 (online)

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Abstract

Background: Remote extracranial mestastases of glioblastoma multiforme (GBM) are uncommon, while cutaneous seeding at a distance from the operative site appears to be even more unusual.

Case report: A 63-year-old man presented with focal seizures and mental impairment. Computed tomography (CT) scan revealed a left frontoparietal mass. He underwent a gross total removal of the tumor. The tissue diagnosis was that of a GBM. Seven months later, the patient developed a left scapular subcutaneous mass. Fine-needle aspiration cytology (FNAC) was performed and the cytological findings disclosed again a GBM. One month later, after clinical deterioration, a repeat magnetic resonance imaging (MRI) scan was carried out which demonstrated two new distinct lesions in the opposite hemisphere, as in a multifocal GBM. Both lesions were biopsed under stereotactic guidance and the recurrence of GBM was confirmed. The patient died ten months after the primary diagnosis of the intracranial GBM.

Conclusion: Improved diagnostic modalities and prolonged survival have increased the likelihood of detection of extracranial mestastases from GBM. This potential may be greater in multifocal GBM. FNA is a valuable method for the definite diagnosis of metastatic GBMs. Although several theories have been postulated, the route of remote cutaneous dissemination and the mechanism of multifocal recurrence remain to be elucidated.

Zusammenfassung

Hintergrund: Extrakraniale Metastasen eines multiformen Glioblastoms (GBM) sind selten, während die kutane Aussaat entfernt der Operationsstelle noch ungewöhnlicher erscheint.

Fallbericht: Ein 63-jähriger Mann präsentierte sich mit fokalen Anfällen und mentaler Störung. Das CCT zeigte eine links-frontoparietale Raumforderung. Der Patient unterzog sich einer radikalen Entfernung des Tumors. Der histologische Befund lautete auf GBM. Sieben Monate später entwickelte der Patient eine linksseitige skapuläre Raumforderung. Diese wurde mittels Feinnadelaspirations-Zytologie (FNAC) biopsiert, und die zytologische Untersuchung ergab erneut GBM. Einen Monat später, nach klinischer Verschlechterung, wurde ein erneutes MRT vorgenommen. Dieses zeigte zwei neue Läsionen entfernt des Primärtumors, in der gegenüberliegenden Hemisphäre. Beide Läsionen wurden stereotaktisch biopsiert und bestätigten die Diagnose GBM-Rezidiv. Der Patient starb zehn Monate nach der Erstdiagnose des intrakraniellen GBM.

Schlussfolgerung: Verbesserte diagnostische Modalitäten und längere Überlebensrate erhöhen die Wahrscheinlichkeit extrakranieller Metastasen des GBM. FNAC ist eine wertvolle Methode in der endgültigen Diagnose des metastatischen GBM. Trotz unterschiedlicher Theorien, muss der Weg der Dissemination und der Mechanismus des multifokalen Wiederauftretens weiter untersucht werden.

Key words

glioblastoma multiforme - extracranial metastasis - cutaneous glioblastoma multiforme - fine needle aspiration - multifocal glioma

Schlüsselwörter

Multiformes Glioblastom - extrakraniale Metastase - multiforme Hautglioblastome - Feinnadelaspiration - multifokales Gliom

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Correspondence

Dr. P. P. Tsitsopoulos

Department of Neurosurgery

Hippokratio General Hospital

Aristotle University

Konstantinoupoleos 49

54642 Thessaloniki

Greece

Phone: +3(0)/2310/89 23 32

Fax: +3(0)/2310/99 29 45

Email: par_tsits@yahoo.gr