Department of Neurosurgery, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece.
Spine (Phila Pa 1976). 2010 Apr 1;35(7):E264-9. doi: 10.1097/BRS.0b013e3181c11748.
Case report.
To report a case and review the literature on glioblastoma multiforme (GBM) with drop-like metastasis to the spine.
GBM constitutes the most common adult malignant brain tumor with poor prognosis. Spinal metastases of this malignancy are quite rare and dissemination usually occurs late in the course of the disease. However, recent advances in cancer treatment prolongate survival and provide adequate time for these metastases to give clinical symptoms.
We hereby present a case of a 57-year-old woman with a history of pineal GBM treated by stereotactic biopsy, chemotherapy, and radiotherapy, readmitted 38 months later due to gait disturbance, spastic paraparesis, edema of lower limbs, bilateral positive Babinski response, and loss of bladder control. A contrast-enhanced magnetic resonance imaging demonstrated an intramedullary lesion extending from C7 to T3 level. A T1 and T2 laminectomy was undertaken followed by extensive biopsy.
Histologic examination was consistent with GBM. No further treatment was given, and the patient died 2 months after the diagnosis of the spinal metastasis.
Spinal metastases should be commonly suspected in patients with a history of intracranial GBM who complain about symptoms not explained by the primary lesion.Glioblastoma multiforme (GBM) was first described by Rudolph Virchow in 1863 and represents the most common and most malignant tumor of the cerebral hemispheres, usually arising between the ages of 40 and 60 years. The incidence in Europe and North America is 2 to 3 cases/100,000 per year, and 75% of the patients die within 18 months after diagnosis. It is an infiltrating malignancy that recurs locally and it may spread along compact fiber pathways such as corpus callosum, optic irradiation, anterior commisure, and fornix or via cerebrospinal fluid (CSF) pathways. However, when GBM is under apparent control, spinal metastases are clinically rarely detected. Although involvement of the spinal cord (SC) has been noted with increasing frequency in recent years, literature provides only a few well documented cases.
病例报告。
报告一例多形性胶质母细胞瘤（GBM）伴有滴状转移至脊柱的病例，并复习相关文献。
GBM 是最常见的成人恶性脑肿瘤，预后差。这种恶性肿瘤的脊柱转移相当罕见，通常在疾病晚期发生扩散。然而，癌症治疗的最新进展延长了生存期，为这些转移灶出现临床症状提供了足够的时间。
我们在此报告一例 57 岁女性患者，病史为松果体 GBM，行立体定向活检、化疗和放疗治疗，38 个月后因步态障碍、痉挛性截瘫、下肢水肿、双侧巴氏征阳性和膀胱控制丧失而再次入院。增强磁共振成像显示 C7 至 T3 水平的髓内病变。行 T1 和 T2 椎板切除术，随后进行广泛活检。
组织学检查符合 GBM。未给予进一步治疗，患者在诊断为脊柱转移后 2 个月死亡。
对于有颅内 GBM 病史并出现无法用原发病灶解释的症状的患者，应普遍怀疑存在脊柱转移。多形性胶质母细胞瘤（GBM）于 1863 年由鲁道夫·菲尔绍首次描述，是大脑半球最常见和最恶性的肿瘤，通常发生在 40 至 60 岁之间。欧洲和北美的发病率为每 10 万人每年 2 至 3 例，75%的患者在诊断后 18 个月内死亡。它是一种局部浸润性恶性肿瘤，可能沿胼胝体、视神经照射、前连合和穹窿等致密纤维途径或通过脑脊液（CSF）途径扩散。然而，当 GBM 得到明显控制时，临床上很少发现脊柱转移。尽管近年来脊髓（SC）受累的报道越来越多，但文献仅提供了少数有明确记录的病例。
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