Extra-neural metastases of malignant gliomas: myth or reality?

Abstract

Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years-despite debulking surgery, radiotherapy and cytotoxic chemotherapy-with a median survival of 9-12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases.

Figure 1.

CT-scan axial imaging showing the brain after neurosurgery; a cavity was seen with blood.

Figure 2.

Photomicrograph demonstrating histological findings of the mediastinal lymph node metastasis. Positive immunostaining for glial fibrillary acid protein of lymph node (HES 200).

Figure 3.

Angio CT-scan showing the metastatic lesions from GBM in the left inferior lobe and in the pleural cavity.