Abstract
To demonstrate clinical characteristics of symptomatic spinal metastases of intracranial glioblastoma multiforme (GBM) and different spreading mechanisms relating to astrocytic cell differentiation, we present an extraordinary case of a 47-year-old patient with rapid progressive paraplegia due to coincident intramedullary and leptomeningeal dissemination of a supratentorial GBM. Serial biopsies of the intracranial, leptomeningeal, and intramedullary GBM lesions of our patient were analyzed for glial fibrillary acidic protein (GFAP). Furthermore, we present 19 additional cases of intracranial GBM with symptomatic spinal seeding, identified through literature review. GFAP expression was high in intracranial and intramedullary tumors, but low in leptomeningeal dissemination of our patient. Mean patient age was 45 years. Mean interval between identification of spinal metastases and death was 4.5 months. Mean overall survival was 18.6 months. Location of symptomatic spinal metastases was more frequently leptomeningeal (14 cases) than intramedullary (7 cases). The case presented herein supports the hypothesis of higher incidence of low GFAP expression in GBM cells in leptomeningeal manifestations after primary intracranial GBM. Because of the proposed tendency for early leptomeningeal spread from primary tumors with low astrocytic differentiation (low GFAP expression), patients with these tumors should be followed more closely to identify leptomeningeal tumor progression early on. Early identification of leptomeningeal spread could enable these patients to benefit from radiation therapy before they develop severe neurological deficits, which might translate into longer acceptable quality of life for these mostly young patients. This is an important finding, but further prospective studies are needed to verify our observations.
References
Arita N, Taneda M, Hayakawa T (1994) Leptomeningeal dissemination of malignant gliomas Incidence, diagnosis and outcome. Acta Neurochir (Wien) 126(2–4):84–92
Balhuizen JC, Bots GT, Schaberg A, Bosman FT (1978) Value of cerebrospinal fluid cytology for the diagnosis of malignancies in the central nervous system. J Neurosurg 48(5):747–753
Banczerowski P, Simó M, Sipos L, Slowik F, Benoist G, Veres R (2003) Primary intramedullary glioblastoma multiforme of the spinal cord: report of eight cases. Ideggyogy Sz 56(1–2):28–32
Buhl R, Barth H, Hugo HH, Hutzelmann A, Mehdorn HM (1998) Spinal drop metastases in recurrent glioblastoma multiforme. Acta Neurochir (Wien) 140(10):1001–1005
Elliott JP, Keles GE, Waite M, Temkin N, Berger MS (1994) Ventricular entry during resection of malignant gliomas: effect on intracranial cerebrospinal fluid tumor dissemination. J Neurosurg 80(5):834–839
Hamilton MG, Tranmer BI, Hagen NA (1993) Supratentorial glioblastoma with spinal cord intramedullary metastasis. Can J Neurol Sci 20(1):65–68
Hübner F, Braun V, Richter HP (2001) Case reports of symptomatic metastases in four patients with primary intracranial gliomas. Acta Neurochir (Wien) 143(1):25–29
Jung T-Y, Jung S, Kim I-Y, Kang S-S, Kim S-H (2007) High grade gliomas: neuraxis dissemination pattern and prognosis. Neurosurg Q 17(3):151–155
Karaca M, Andrieu MN, Hicsonmez A, Guney Y, Kurtman C (2006) Cases of glioblastoma multiforme metastasizing to spinal cord. Neurol India 54(4):428–430
Kocher M, Frommolt P, Borberg SK, Rühl U, Steingräber M, Niewald M, Staar S, Stuschke M, Becker G, Fischedick AR, Herfarth K, Grauthoff H, Müller RP (2008) Randomized study of postoperative radiotherapy and simultaneous temozolomide without adjuvant chemotherapy for glioblastoma. Strahlenther Onkol 184(11):572–579
Lam CH, Cosgrove GR, Drislane FW, Sotrel A (1991) Spinal leptomeningeal metastasis from cerebral glioblastoma. Appearance on magnetic resonance imaging. Surg Neurol 35(5):377–380
Lindsay A, Holthouse D, Robbins P, Knuckey N (2002) Spinal leptomeningeal metastases following glioblastoma multiforme treated with radiotherapy. J Clin Neurosci 9(6):725–728
Onda K, Tanaka R, Takahashi H, Takeda N, Ikuta F (1989) Cerebral glioblastoma with cerebrospinal fluid dissemination: a clinicopathological study of 14 cases examined by complete autopsy. Neurosurgery 25(4):533–540
Pohar S, Taylor W, Chandan VS, Shah H, Sagerman RH (2004) Primary presentation of glioblastoma multiforme with leptomeningeal metastasis in the absence of previous craniotomy: a case report. Am J Clin Oncol 27(6):640–641
Schwaninger M, Patt S, Henningsen P, Schmidt D (1992) Spinal canal metastases: a late complication of glioblastoma. J Neurooncol 12(1):93–98
Stark AM, Nabavi A, Mehdorn HM, Blömer U (2005) Glioblastoma multiforme—report of 267 cases treated at a single institution. Surg Neurol 63(2):162–169
Stark AM, Maslehaty H, Hugo HH, Mehdorn HM (2010) Glioblastoma of the cerebellum and brainstem: report of seven cases and review of the literature. J Clin Neurosci 17(10) (expected publication)
Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) European Organisation for Research, Treatment of Cancer Brain Tumor, Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996
Toledano Delgado R, Garcia N, Riva-Amarante E, Rodríguez Pascual J, García Leal R, Sendra Tello J (2006) Spinal leptomeningeal metastasis from cerebral glioblastoma: case report. Neurologia 21(7):378–381
Vertosick FT Jr, Selker RG (1990) Brain stem and spinal metastases of supratentorial glioblastoma multiforme: a clinical series. Neurosurgery 27(4):516–521
Wagner S (2006) Secondary dissemination in children with high grade malignant gliomas and diffuse intrinsic pontine gliomas. Br J Cancer 95(8):991–997
Acknowledgments
We thank Professor Hans Landolt, head of the Department of Neurosurgery, Kantonsspital Aarau, Switzerland for his support.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Maslehaty, H., Cordovi, S. & Hefti, M. Symptomatic spinal metastases of intracranial glioblastoma: clinical characteristics and pathomechanism relating to GFAP expression. J Neurooncol 101, 329–333 (2011). https://doi.org/10.1007/s11060-010-0257-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11060-010-0257-y