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Neuroradiology Case of the Week
Case 343
August 2008
Balasubramanya Kolar, MD and
P-L Westesson, MD, PhD, DDS
Clinical
Presentation: A 28-year-old male patient with a previously diagnosed left temporal glioblastoma multiforme, had undergone resection of the lesion with chemotherapy and radiation, presented for follow-up MRI to evaluate progression of the disease process.
Imaging Findings: MR imaging showed a large recurrent lesion in the left temporal lobe which extended inferiorly into the infratemporal fossa and left parapharyngeal space. Another enhancing nodule superior to the lesion was also noted along the left temporal bone which points extracranially. Small enhancing leptomeningeal nodule were also noted along the cervical spinal cord.
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Figure 1: Axial FLAIR image shows recurrent tumor in the left temporal region bulging out of the temporal bone. |
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Figure 2A&B: Axial FLAIR (A) and post-contrast T1-weighted image (B) show an enhancing lesion within the left parapharyngeal and infratemporal regions.
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| Figure 3: Coronal T1 post-contrast image shows enhancement of the recurrent tumor with a small nodule in the superior aspect also extending out of the temporal bone. |
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| Figure 4A&B: Coronal (A) and axial post-contrast T1-weighted (B) images show an enhancing leptomeningeal nodule (arrow) along the left lateral surface of the cervical spinal cord. |
Diagnosis: Recurrent glioblastoma with extracranial extension and leptomeningeal metastases
Discussion: Gliomas are the most common primary tumors of the brain. Multifocal and multicentric gliomas are also common entities, however extracranial spread of these lesions or metastases is generally thought to be rare.
Spread or dissemination within the neuraxis [1] is commoner than spread to other areas like the vertebral body, liver, and peritoneum which have also been reported [2-4].
Craniotomy and radiation therapy have been found as common factors in all cases of metastatic dissemination. A large proportion of patients have also received chemotherapy. The occurrence of a gliomatous tumor outside the central nervous system in the absence of surgery is extremely rare and metastatic dissemination of glioblastoma multiforme is often preceded by violation of normal anatomical barriers [1]. This is frequently seen as tumor seeding of a biopsy track or peritoneal implants through a ventriculoperitoneal shunt.
The prognosis for patients with such a dissemination is extremely poor. Survival beyond six months is extremely rare [1].
References:
- Ng WH, Yeo TT, Kaye AH. Spinal and extracranial metastatic dissemination of malignant glioma. J Clin Neurosci. 2005 May;12(4):379-82. [PubMed]
- Beauchesne P, Soler C, Mosnier JF. Diffuse vertebral body metastasis from a glioblastoma multiforme: a technetium-99m Sestamibi single-photon emission computerized tomography study. J Neurosurg. 2000 Nov;93(5):887-90. [PubMed]
- Shuto T, Fujino H, Inomori S, et al. Glioblastoma multiforme with liver metastasis--case report. No To Shinkei. 1995 Aug;47(8):772-7. [PubMed]
- Newton HB, Rosenblum MK, Walker RW. Extraneural metastases of infratentorial glioblastoma multiforme to the peritoneal cavity. Cancer. 1992 Apr 15;69(8):2149-53. [PubMed]
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