Basem Jade I, Seidman Roberta, Franceschi Dinko, Dashti Reza
Department of Neurological Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, United States.
Department of Pathology, Renaissance School of Medicine at Stony Brook University, Stony Brook, United States.
Surg Neurol Int. 2025 Mar 28;16:102. doi: 10.25259/SNI_969_2024. eCollection 2025.
Glioblastoma (isocitrate dehydrogenase [IDH]-wildtype, WHO Grade 4) is known to have a high recurrence rate with poor management of morbidity and mortality. Metastatic spread of glioblastomas is rare with extraneural osseous spread having been reported in under 100 cases. In this report, a case of glioblastoma with widespread extraneural metastatic lesions, including distal extremities, is presented.
A 70-year-old female presented with progressive word-finding difficulty and confusion. Brain magnetic resonance imaging (MRI) revealed a 5 × 7 cm left temporal solid and cystic mass with heterogenous contrast enhancement and significant surrounding edema. She underwent near-total tumor resection, and the pathological diagnosis was glioblastoma, (IDH-wildtype, WHO grade 4), with sarcomatous and primitive neuronal components. She received radiation therapy and temozolomide over 4 months. At 5 months postoperative, she presented with new bilateral lower extremity weakness and left facial droop. MRI and positron emission tomography scans revealed local recurrence and metastatic lesions to vertebrae, extremities, and lymph nodes.
Previous research into rare glioblastoma bone metastases supports the theories of spread through hematogenous routes, surgical disruption, glymphatic system, and potential genetic susceptibility. However, no literature to date can adequately explain the distal limb metastases presented in this case, which shows the necessity for further understanding of this pathology.
胶质母细胞瘤（异柠檬酸脱氢酶[IDH]野生型，世界卫生组织4级）复发率高，对发病率和死亡率的管理不佳。胶质母细胞瘤的远处转移很少见，据报道，神经外骨转移病例不到100例。在本报告中，介绍了1例患有广泛神经外转移病灶（包括远端肢体）的胶质母细胞瘤病例。
一名70岁女性出现进行性找词困难和意识模糊。脑部磁共振成像（MRI）显示左侧颞叶有一个5×7cm的实性和囊性肿块，伴有不均匀强化和明显的周围水肿。她接受了近全肿瘤切除术，病理诊断为胶质母细胞瘤（IDH野生型，世界卫生组织4级），伴有肉瘤样和原始神经成分。她在4个月内接受了放射治疗和替莫唑胺治疗。术后5个月，她出现了新的双侧下肢无力和左侧面部下垂。MRI和正电子发射断层扫描显示局部复发以及椎体、肢体和淋巴结的转移病灶。
先前对罕见的胶质母细胞瘤骨转移的研究支持通过血行途径、手术破坏、淋巴系统和潜在遗传易感性传播的理论。然而，迄今为止，尚无文献能够充分解释该病例中出现的远端肢体转移，这表明有必要进一步了解这种病理情况。
