Extraneural Metastasis of Primary Glioma Occurring in a Setting of Occupational Ionizing Radiation Exposure

Abstract

Malignant gliomas account for 60% of all primary brain tumors in adults. Glioblastoma Multiforme (GBM) is the most common primary glial tumor with a dismal prognosis and a median survival of approximately 14 months. Extra-neural metastases from primary brain tumors are unusual with an incidence rate of less than 2%. This has been attributed to factors such as short survival, lack of true lymphatics in the CNS, and physical barriers provided by the dura, extracellular matrix, and basement membrane. Although most GBMs occur sporadically, there is a known association with therapeutic radiation exposure and with work in nuclear disaster cleanup. To our knowledge, no case of GBM with metastasis occurring in a patient with occupational radiation exposure currently exists in the literature. In this article, we present a case of GBM with lung metastasis occurring in a 51-year-old Caucasian male, whose history is significant for occupational exposure to ionizing radiation, and review the literature on GBM risk factors and potential mechanisms of metastasis.

Figure 1

(a) and (b): pre- and postcontrast MRI demonstrating large right frontal ring-enhancing mass, October 2008. (c) Chest CT with mass in the left lung, May 2009.

Figure 2

Brain tumor. (a) The tumor is composed of large and small cells (LFB/H&E, 100x). (b) The tumor contains many multinucleated giant cells (LFB/H&E, 400x). (c) The tumor displaying necrosis with palisade (H&E, 100x).

Figure 3

Lung tumor. (a) The tumor forms a solid mass (left side) with bordering alveoli (right side) (H&E, 100x). (b) Necrosis in the lung tumor (H&E, 100x). (c) GFAP immunostain demonstrating immunopositive tumor cells in the lung with immunonegative pulmonary cells (right side) (GFAP immunostain, 100x).