Postoperative Extra-Cranial Metastasis of Glioblastoma in A 46 Years Old Man: A Case Report

Introduction: glioblastoma (WHO grade IV) is the most common malignant tumor of neural tissues in adults as a primary tumor. This malignancy shows aggressive behavior with median survival of about one year despite surgical resection, chemotherapy and radiation. Because of blood brain barrier and short median survival of patients with glioblastoma; metastasis of this tumor is very rare in clinic. Herein we present a case of 46 years old man with metastasis of glioblastoma to pelvic activity and cervical lymph node.Case presentation: A 46 years old man came to our hospital with chief complain of headache and visual impairment. After neuroradiologic evaluation surgery for resection was done. Pathologic examination of tumor confirmed the diagnosis of glioblastoma multiforme. Cytogenetic study of tumor cells confirms GBM IDH1 wild type with TERT mutation and EGFR amplification. Two month after surgical resection, due to local recurrence the patient underwent second surgery . 6 months after that the patient underwent core needle biopsy of pelvic mass found in work ups and suspicious cervical lymph node found in examination. Both specimens of core needle biopsies revealed histological features same as resected brain tumor including neoplastic growth of malignant astrocytic cells with nuclear atypia and pleomorphism as well as pseudo-palisading in background of fibrotic and necrotic tissue. IHC study also confirm metastatic glioblastoma.Conclusions: Glioblastoma is one of the hardest tumor to treat in neurosurgical management. Blood brain barrier, lack of true lymphatic system and low survival modes this tumor very rare to metastasis. Almost all cases of glioblastoma metastasis had undergone any manipulation; this fact suggests that iatrogenic intra-vascular seeding of tumor cells at the time of resection and disruption of blood brain barrier could cause extra-neural metastasis. In this case we report a rare location of metastasis means pelvic cavity. All researches in this field suggest the median time of detection of metastasis about 8.5 months after diagnosis of GBM and time to death of about 1.5 month after metastasis . In our case the time of metastasis was about 8 month and time of death was less than 2 months. Our patient had many risk factors of metastasis including two surgeries, radiation and not getting chemotherapy and most important than all is aggressive behavior of primary GBM- IDH1 wild type/TERT+/EGFR amp+/MGMT+ in cytogenetic evaluation.

Keywords:

glioblastoma , metastasis , brain tumor , pelvic cavity