Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.
Department of Pathology, Tianjin Union Medical Center, Tianjin, 300121, China.
BMC Med Imaging. 2020 Jul 31;20(1):89. doi: 10.1186/s12880-020-00488-x.
Metastatic glioblastoma presenting as a solitary osteolytic cervical vertebral mass without primary brain tumor relapse is extremely rare with only 1 reported case in the literature. Because of its rarity, it can be easily overlooked and misdiagnosed, posing a diagnostic dilemma.
A 51-year-old man with right temporal glioblastoma was initially treated by tumor resection, radiotherapy and chemotherapy. Eighteen months after surgery, he was readmitted with complaints of neck pain for 2 weeks. Follow-up magnetic resonance imaging (MRI) and fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) revealed a solitary FDG-avid osteolytic lesion in the 4th cervical vertebral body without other abnormal FDG-uptake in the body and in the absence of local recurrence at the resection cavity. Because of the sudden worsening situation and intractable neck pain, the patient underwent tumor resection. Postoperatively, the pain was obviously reduced and the situation was improved. Interestingly, the immunohistochemical findings of glial fibrillary acidic protein (GFAP) indicated the characteristic of metastatic glioblastoma, despite that the histopathological findings of Hematoxylin & Eosin (H&E) staining was suspicious of osteoclastoma. According to the clinical history, imaging findings, pathological and immunohistochemical results, a final diagnosis of solitary vertebral metastasis from glioblastoma without central nervous system (CNS) relapse was confirmed. Then, the patient received radiotherapy on spine and adjuvant chemotherapy with temozolomide. However, he died suddenly 2 months after the tumor resection, nearly 21 months after the initial diagnosis.
We emphasize that metastatic glioblastoma should be considered in the differential diagnosis of a solitary FDG-avid osteolytic vertebral mass on PET/CT. And the diagnosis of extracranial metastasis (ECM) from glioblastoma can be achieved through clinical history, imaging findings, pathological examination, and immunohistochemical staining with GFAP.
文献中仅报道过 1 例，表现为无原发性脑肿瘤复发的孤立性溶骨性颈椎肿块的转移性神经胶质瘤极为罕见。由于其罕见性，很容易被忽视和误诊，从而造成诊断上的困境。
一名 51 岁男性，最初因右侧颞叶神经胶质瘤接受了肿瘤切除术、放疗和化疗。术后 18 个月，因颈部疼痛 2 周再次入院。随访磁共振成像（MRI）和氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）显示第 4 颈椎体有一个孤立的 FDG 摄取溶骨性病变，身体其他部位无异常 FDG 摄取，且切除腔无局部复发。由于病情突然恶化和颈部疼痛难以控制，患者接受了肿瘤切除术。术后，疼痛明显减轻，病情改善。有趣的是，胶质纤维酸性蛋白（GFAP）的免疫组化结果表明存在转移性神经胶质瘤的特征，尽管苏木精和伊红（H&E）染色的组织病理学结果可疑为破骨细胞瘤。根据临床病史、影像学表现、病理和免疫组化结果，最终诊断为无中枢神经系统（CNS）复发的孤立性椎体转移神经胶质瘤。然后，患者接受了脊柱放疗和替莫唑胺辅助化疗。然而，在肿瘤切除后 2 个月，即初次诊断后近 21 个月，他突然死亡。
我们强调，在 PET/CT 上，对于孤立性 FDG 摄取溶骨性椎骨肿块，应考虑转移性神经胶质瘤的鉴别诊断。通过临床病史、影像学表现、病理检查和 GFAP 的免疫组化染色，可以诊断出神经胶质瘤的颅外转移（ECM）。
