Jang Cheolwon, Cho Byung-Kyu, Hwang Sung Hwan, Shin Hyung Jin, Yoon Sang Hoon
Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam, Korea.
Brain Tumor Res Treat. 2022 Jul;10(3):183-189. doi: 10.14791/btrt.2022.0013.
Approximately two-thirds of glioblastoma (GBM) patients progress to leptomeningeal spread (LMS) within two years. While 90% of LMS cases are diagnosed during the progression and/or recurrence of GBM (defined as secondary LMS), LMS presentation at the time of GBM diagnosis (defined as primary LMS) is very rare. F-fluorodeoxy glucose positron emission tomography computed tomography (F-FDG PET/CT) study helps to diagnose the multifocal spread of the malignant primary brain tumor. Our patient was a 31-year-old man with a tumorous lesion located in the right temporal lobe, a wide area of the leptomeninges, and spinal cord (thoracic 5/6, and lumbar 1 level) involvement as a concurrent manifestation. After the removal of the right temporal tumor, the clinical status progressed rapidly, showing signs of increased intracranial pressure and hydrocephalus caused by LMS. He underwent a ventriculoperitoneal shunt a week after craniotomy. During management, progression of cord compression, paraplegia, bone marrow suppression related to radiochemotherapy, intercurrent infections, and persistent ascites due to peritoneal metastasis of the LMS through the shunt system was observed. The patient finally succumbed to the disease nine months after the diagnosis of simultaneous GBM and LMS. The overall survival of primary LMS with GBM in our case was nine months, which is shorter than that of secondary LMS with GBM. The survival period after the diagnosis of LMS did not seem to be significantly different between primary and secondary LMS. To determine the prognostic effect and difference between primary and secondary LMS, further cooperative studies with large-volume data analysis are warranted.
大约三分之二的胶质母细胞瘤（GBM）患者会在两年内进展为软脑膜播散（LMS）。虽然90%的LMS病例是在GBM进展和/或复发期间被诊断出来的（定义为继发性LMS），但在GBM诊断时出现的LMS表现（定义为原发性LMS）非常罕见。氟脱氧葡萄糖正电子发射断层扫描计算机断层扫描（F-FDG PET/CT）研究有助于诊断恶性原发性脑肿瘤的多灶性播散。我们的患者是一名31岁男性，右颞叶有一个肿瘤性病变，软脑膜广泛受累，脊髓（胸5/6和腰1水平）也有并发受累。切除右颞叶肿瘤后，临床状况迅速进展，出现了由LMS导致的颅内压升高和脑积水迹象。开颅术后一周，他接受了脑室腹腔分流术。在治疗过程中，观察到脊髓压迫进展、截瘫、与放化疗相关的骨髓抑制、并发感染以及由于LMS通过分流系统发生腹膜转移导致的持续性腹水。该患者在同时诊断为GBM和LMS九个月后最终死于该病。我们病例中GBM合并原发性LMS的总生存期为九个月，短于GBM合并继发性LMS的总生存期。原发性和继发性LMS诊断后的生存期似乎没有显著差异。为了确定原发性和继发性LMS的预后影响及差异，有必要进行进一步的大数据分析合作研究。
