RESUMEN
This article presents the rare case of a 54-year-old gentleman with primary glioblastoma developing multiple extracranial metastases 7 months after diagnosis. Initially, the patient complained of progressive headaches, confusion, and weakness of the left arm. Magnetic resonance imaging of the brain showed a right temporoparietal tumor with substantial surrounding subcortical edema and midline shift to the left. Two consecutive craniotomies resulted in complete microsurgical resection of the lesion. Histology was consistent with a World Health Organization grade IV, IDH-wildtype glioblastoma. Further treatment was standard chemoradiation including intensity-modulated radiotherapy with oral temozolomide chemotherapy. Seven months after diagnosis, the cranial lesion progressed, and the patient developed painful metastases in multiple bones and suspicious right-sided cervical lymph nodes. Immunohistochemistry and molecular signature supported the case of a metastatic glioblastoma. Further treatment was palliative radiotherapy of the spinal lesions along with symptomatic pain management. Extracranial metastasis of glioblastoma is a rare complication of which only a few cases have been reported in the literature. Little is known about the precise mechanisms of tumor dissemination and the appropriate treatment.
Asunto(s)
Neoplasias Encefálicas , Glioblastoma , Metástasis Linfática , Neoplasias de la Columna Vertebral , Humanos , Glioblastoma/secundario , Glioblastoma/patología , Glioblastoma/radioterapia , Masculino , Persona de Mediana Edad , Neoplasias Encefálicas/secundario , Neoplasias Encefálicas/radioterapia , Metástasis Linfática/patología , Metástasis Linfática/radioterapia , Neoplasias de la Columna Vertebral/secundario , Neoplasias de la Columna Vertebral/radioterapia , Terapia Combinada , Imagen por Resonancia Magnética , Cuidados PaliativosRESUMEN
PURPOSE: Complete resection is crucial for the management of sphenoid wing meningiomas (SWM). We hypothesized that specific anatomical growth patterns are predictive for recurrence and worse prognosis. We therefore analyzed the extension patterns of SWM and correlated them with intraoperative findings, extent of resection and recurrence rate. METHODS: MRI and CT scans were utilized to analyze soft tissue and bone extension, respectively. Soft tissue extension was quantified using four, bone infiltration using eight anatomical landmarks. The extent of resection was graded according to the Simpson classification (grade I-V). Finally,the growth pattern analysis was correlated with recurrence rate. RESULTS: We included 44 patients, 37 female (84.1%) and 7 male (15.9%). Tumor recurrence was observed in 13 patients (29.5%). Patients with recurrent tumors had a significantly worse Simpson score (p=0.01). Soft tissue spread into the cavernous sinus and bony infiltration of the superior orbital fissure was associated with a poor Simpson grade (p=0.001). Bony infiltration of the orbital roof superior orbital fissure was highly predictive for tumor recurrence (p=0.002). CONCLUSIONS: Structured radiological and anatomical analysis of the SWM growth pattern may influence the surgical strategy and facilitate the management and prognostication of patients with SWM.
Asunto(s)
Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/cirugía , Meningioma/diagnóstico , Meningioma/cirugía , Adulto , Anciano , Seno Cavernoso/diagnóstico por imagen , Seno Cavernoso/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Recurrencia Local de Neoplasia/radioterapia , Órbita/diagnóstico por imagen , Órbita/patología , Valor Predictivo de las Pruebas , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
INTRODUCTION: Adult malignant optic nerve gliomas are rare and rapidly fatal visual pathway tumours. They represent a clinical entity different from the more common childhood benign optic nerve gliomas, which are frequently associated with neurofibromatosis I. CASE REPORT: A 61-year-old woman presented with rapidly progressing right vision loss, lower altitudinal visual field defect and papilloedema. MRI showed intraorbital and intracranial swelling of the right optic nerve. Resection of the intracranial part of the right optic nerve up to the chiasm revealed anaplastic astrocytoma grade III. Within 1 year, the patient died of leptomeningeal metastasis despite radiotherapy. Clinical and MRI evaluation of the left eye and optic nerve were normal at all times. DISCUSSION: Unilateral adult malignant glioma of the optic nerve is exceptional. The final diagnosis was only confirmed by optic nerve biopsy. In the literature, only one patient has been reported with a unilateral tumour manifestation; he was lost to follow-up 3 months later. All other cases were bilateral. To date, 44 case reports of adult malignant optic nerve glioma have been published, either malignant astrocytoma or glioblastoma. These tumours can mimic optic neuritis in their initial presentation. The diagnosis is seldom made before craniotomy. On MRI images, malignant glioma cannot be distinguished from optic nerve enlargement due to other causes. Although radiotherapy appears to prolong life expectancy, all presently available treatment options (radiation, surgery, radio-chemotherapy) are of limited value. Most patients go blind and die within 1 or 2 years.