Presentation of Two Cases with Early Extracranial Metastases from Glioblastoma and Review of the Literature

Abstract

Extracranial metastases from glioblastoma are rare. We report two patients with extracranial metastases from glioblastoma. Case 1 concerns a 59-year-old woman with multiple metastases that spread early in the course of disease. What makes this case unusual is that the tumor had grown into the falx close to the straight sinus and this might be an explanation to the early and extensive metastases. Case 2 presents a 60-year-old man with liver metastasis found at autopsy, and, in this case, it is more difficult to find an explanation. This patient had two spontaneous intracerebral bleeding incidents and extensive bleeding during acute surgery with tumor removal, which might have induced extracranial seeding. The cases presented might have hematogenous spreading in common as an explanation to extracranial metastases from GBM.

Figure 1

Case  1. (a) Preoperative post-contrast enhanced T1 weighted MRI showing the localization of the tumor in close proximity to the falx. (b) Fused FDG PET/CT scanning at liver level 5 months after diagnosis of GBM showing multiple metabolically active metastases (blue) and inactive liver cyst (white). (c) Frontal maximum intensity projection (MIP) image of whole body FDG PET scanning identifying disseminated metastatic spread to lymph nodes (green), lungs (red), bone (purple), and liver (blue). Physiological excretion to intestines, kidneys, and the bladder.

Figure 2

Histopathology from both cases. (a) HE staining (×20) of cervical lymph node metastasis from case 1. (b) GFAP staining (×40) of cervical lymph node metastasis from case 1. (c) GFAP staining (×10) of liver metastasis from case 2.