Extracranial metastases in secondary glioblastoma multiforme: a case report
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CASE REPORT
Open Access
Extracranial metastases in secondary glioblastoma multiforme: a case report Jessica Rossi1, Lucia Giaccherini2, Francesco Cavallieri3,4* , Manuela Napoli5, Claudio Moratti5, Elisabetta Froio6, Silvia Serra6, Alessandro Fraternali7, Reza Ghadirpour8, Salvatore Cozzi2, Patrizia Ciammella2, Corrado Iaccarino8, Rosario Pascarella5, Franco Valzania3 and Anna Pisanello3
Abstract Background: Glioblastoma (GBM) is known for its devastating intracranial infiltration and its unfavorable prognosis, while extracranial involvement is a very rare event, more commonly attributed to IDH wild-type (primary) GBM evolution. Case presentation: We present a case of a young woman with a World Health Organization (WHO) grade II Astrocytoma evolved to WHO grade IV IDH mutant glioblastoma, with subsequent development of lymphatic and bone metastases, despite the favorable biomolecular pattern and the stability of the primary brain lesion. Conclusions: Our case highlights that grade II Astrocytoma may evolve to a GBM and rarely lead to a secondary metastatic diffusion, which can progress quite rapidly; any symptoms referable to a possible systemic involvement should be carefully investigated. Keywords: Extracranial, Glioblastoma, IDH mutant, Metastases, Secondary
Background Glioblastoma (GBM) is the most frequent and malignant brain tumor, characterized by a rapid progression and unfavorable prognosis [1]. IDH wild-type (primary) GBM develops de novo in elderly (60–80 years) patients representing approximately the 90% of all cases of GBM, while IDH mutant (secondary) GBM is typical of younger people, has a more positive biomolecular pattern and is associated with a better prognosis [1]. Despite its highly invasive nature, GBM metastases are rare and this is putatively attributed to the short overall survival and the lack of a favorable environment for an extracranial spreading of tumor cells [2, 3]. Moreover, metastases usually occur after primary GBM, while extracranial * Correspondence: [email protected] 3 Neurology Unit, Neuromotor and Rehabilitation Department, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy 4 Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy Full list of author information is available at the end of the article
involvement from secondary GBM is extremely rare [2, 4]. Here we report the case of a patient presented with a World Health Organization (WHO) grade II astrocytoma which evolved to an IDH mutant GBM (WHO IV) with subsequent extracranial metastatic diffusion.
Case presentation A 29-year-old healthy left-handed woman, admitted to another institution after the appearance of a focal motor epileptic seizure, underwent subtotal surgical removal of a right frontal WHO grade II Astrocytoma in June 2015 (Fig. 1, A1–2). The lesion remained stable at the following six-months follow-up MRI studies until October 2017, when the patient underwent a new brain surgery for neuroradiological findings of locoregional recurrence (Fig. 1, B1–2), with
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