IDH-Wildtype Glioblastoma with Leptomeningeal Carcinomatosis: A Case Report

Abstract

Glioblastoma is the most common malignant tumor of the central nervous system. Leptomeningeal dissemination is rare and usually occurs in the late stages of the disease. We report a 26-year-old man diagnosed with IDH-wildtype, WHO grade 4 glioblastoma located in the right thalamus. Despite radiological regression of the tumor after chemoradiotherapy, the patient developed paraparesis seven months later. Spinal magnetic resonance imaging showed diffuse leptomeningeal enhancement extending from C1 to T9, consistent with leptomeningeal carcinomatosis. The patient received palliative treatment and subsequently died due to pneumonia-related complications. Although leptomeningeal dissemination of glioblastoma is uncommon, it is associated with rapid progression and poor prognosis. Therefore, spinal dissemination should be considered in patients with new-onset back pain or limb weakness, even in the presence of radiological regression of the primary tumor.

Keywords

• glioblastoma
• leptomeningeal carcinomatosis
• spinal seeding
• hydrocephalus

Leptomeningeal Karsinomatozlu IDH-Wildtype Glioblastom: Bir Vaka Sunumu

Abstract

Glioblastoma, merkezi sinir sisteminin en sık görülen kötü huylu tümörüdür. Leptomeningeal yayılım nadir görülür ve genellikle hastalığın geç evrelerinde ortaya çıkar. Bu olguda, sağ talamusta yerleşimli IDH-yabanıl tip, WHO derece 4 glioblastoma tanısı alan 26 yaşındaki erkek hasta sunulmaktadır. Kemoradyoterapi sonrasında yapılan manyetik rezonans görüntülemede tümörde gerileme izlenmesine rağmen, yedi ay sonra hastada paraparezi gelişti. Spinal manyetik rezonans görüntüleme, C1-T9 seviyeleri boyunca uzanan yaygın leptomeningeal kontrastlanma ile uyumlu leptomeningeal karsinomatozisi gösterdi. Hasta palyatif tedavi aldı ve daha sonra pnömoniye bağlı komplikasyonlar nedeniyle kaybedildi. Glioblastomanın leptomeningeal yayılımı nadir olmakla birlikte hızlı klinik ilerleme ve kötü prognoz ile ilişkilidir. Bu nedenle, primer tümörde radyolojik gerileme saptansa dahi, yeni başlayan sırt ağrısı veya ekstremite güçsüzlüğü gelişen hastalarda spinal yayılım olasılığı göz önünde bulundurulmalıdır.

Keywords

• GLİOBLASTOM
• LEPTOMENİNGEAL KARSİNOMATOZİS
• SPİNAL SEEDİNG
• HİDROSEFALİ

References

1. 1. Erlich SS, Davis RL. Spinal subarachnoid metastasis from primary intracranial glioblastoma multiforme. Cancer 1978; 42(6): 2854-64.
2. 2. Lam CH, Cosgrove GR, Drislane FW, Sotrel A. Spinal leptomeningeal metastasis from cerebral glioblastoma. Appearance on magnetic resonance imaging. Surg Neurol 1991; 35(5): 377-80.
3. 3. Cairns H, Russell DS. Intracranial and spinal metastases in gliomas of the brain. Brain 1931; 54(4): 377-420.
4. 4. Salazar OM, Rubin P. The spread of glioblastoma multiforme as a determining factor in the radiation treated volume. Int J Radiat Oncol Biol Phys 1976; 1(7-8): 627-37.
5. 5. Vertosick FT Jr, Selker RG. Brain stem and spinal metastases of supratentorial glioblastoma multiforme: A clinical series. Neurosurgery 1990; 27(4): 516-21; discussion 521-2.
6. 6. Scoccianti S, Detti B, Meattini I, Iannalfi A, Sardaro A, Grilli Leonulli B, et al. Symptomatic leptomeningeal and intramedullary metastases from intracranial glioblastoma multiforme: A case report. Tumori 2008; 94(6): 877-81.
7. 7. Grabb PA, Albright AL, Pang D. Dissemination of supratentorial malignant gliomas via the cerebrospinal fluid in children. Neurosurgery 1992; 30(1): 64-71.
8. 8. Jang C, Cho BK, Hwang SH, Shin HJ, Yoon SH. Leptomeningeal spread at the diagnosis of glioblastoma multiforme: A case report and literature review. Brain Tumor Res Treat 2022; 10(3): 183-9.

9. 9. Shah A, Redhu R, Nadkarni T, Goel A. Supratentorial glioblastoma multiforme with spinal metastases. J Craniovertebr Junction Spine 2010; 1(2): 126-9.
10. 10. Pande A, Rajaraman N, Sadiya N, Patil S, Pandian S, Adhithyan R, et al. Spinal drop metastasis of glioblastoma: Two case reports, clinicopathologic features, current modalities of evaluation, and treatment with a review of the literature. World Neurosurg 2021; 146: 261-9.