Bukeo T, Matsumoto Y, Nishimoto A, Tabuchi K
No Shinkei Geka. 1985 Jan;13(1):87-90.
It is generally accepted that the metastases of intracranial glioma to extracranial location are rare. In such a case the minimal criteria proposed originally by Weiss should usually be satisfied if a report is to be considered as an acceptable case of metastasizing central nervous system glioma outside the central nervous system. We report a case of glioblastoma multiforme, fulfilling Weiss' criteria, metastasizing the spinal epidural space. The patient was a 32-year-old male, who underwent craniotomy and subtotal removal of a glioblastoma multiforme in the left parietooccipital area. He was additionally treated with irradiation and chemotherapeutic agents. Twelve months after the craniotomy, he was admitted again to our clinic because of sudden onset of severe lumbago, paraplegia and urinary disturbance. Diagnosis of a spinal epidural tumor was made and laminectomy (Th10-L1) was performed. At operation, an epidural mass was found, however no invasion to the spinal cord or dura was noted. Histological diagnosis of the tumor was glioblastoma multiforme. Although he was treated with radiation, pulmonary metastasis was manifested one month later, and the condition of the patient deteriorated. He died 21 months after the first operation and 8 months after the second operation. Even at the terminal stage, his consciousness was clear without any sign for recurrence of intracranial tumor. The general autopsy was done and multiple metastatic lesions of glioblastoma multiforme in paratracheal and paraaortic lymph node, left pleura, both lungs and spinal cord were observed. The present case suggests that the surgical intervention, irradiation, and chemotherapy may contribute to extracranial metastasis of a glioblastoma.
颅内胶质瘤向颅外转移通常被认为是罕见的。在这种情况下，如果一份报告要被视为中枢神经系统胶质瘤在中枢神经系统外发生转移的可接受病例，通常应满足Weiss最初提出的最低标准。我们报告一例符合Weiss标准的多形性胶质母细胞瘤转移至脊髓硬膜外间隙的病例。患者为一名32岁男性，曾接受开颅手术并次全切除左顶枕区的多形性胶质母细胞瘤。他还接受了放疗和化疗药物治疗。开颅术后12个月，他因突然出现严重腰痛、截瘫和排尿障碍再次入住我们的诊所。诊断为脊髓硬膜外肿瘤并进行了椎板切除术（胸10 - 腰1）。手术中发现硬膜外肿块，但未发现侵犯脊髓或硬脑膜。肿瘤的组织学诊断为多形性胶质母细胞瘤。尽管他接受了放疗，但1个月后出现了肺转移，患者病情恶化。他在第一次手术后21个月、第二次手术后8个月死亡。即使在末期，他的意识仍清晰，没有任何颅内肿瘤复发的迹象。进行了全身尸检，观察到多形性胶质母细胞瘤在气管旁和主动脉旁淋巴结、左胸膜、双肺和脊髓的多处转移病灶。本病例提示，手术干预、放疗和化疗可能促使多形性胶质母细胞瘤发生颅外转移。
