Spinal cord metastasis in a long-term survivor of primary malignant glioblastoma: A case report

Abstract

Glioblastoma (GBM) is the most common type of primary malignant brain tumor. Extracranial metastasis (ECM) is rare and usually indicates poor prognosis. We report a case of a 31-year-old female with GBM who underwent gross total resection followed by standard chemoradiotherapy. For recurrence, she received tumor treating fields and bevacizumab. At 23 months post-surgery, she developed COVID-19 pneumonia treated with dexamethasone, followed by spinal symptoms. MRI revealed L1-L2 lesions, and pathology after lumbar surgery confirmed ECM. Despite further treatment, the patient died of respiratory failure at 28 months. The present case illustrates the aggressive nature of ECM in GBM and the limited efficacy of current therapies in metastatic settings. Surgical resection and chemoradiotherapy remain the mainstay, while emerging treatments may provide hope for recurrent cases. Supportive care plays a critical role in advanced disease stages.

Keywords: ECM; GBM; prognosi; surgical resection; temozolomide.

Figure 1.

Preoperative and postoperative imaging of the intracranial tumor. (A) Axial contrast-enhanced MRI showing a right frontal lobe lesion with surrounding edema. (B) Coronal contrast-enhanced MRI showing the extent of the lesion. (C) Sagittal contrast-enhanced MRI revealing the mass effect and surrounding edema. (D) Axial contrast-enhanced MRI at 2 weeks post-surgery showing no residual tumor. (E) Coronal contrast-enhanced MRI confirming complete resection of the right frontal lesion. (F) Sagittal contrast-enhanced MRI indicating postoperative changes without evidence of tumo The yellow arrows indicate the location of the tumor.

Figure 2.

CT chest images of the lung. (A) Pneumonia following coronavirus disease 2019 infection. (B) Chest CT after high-dose steroid shock therapy. After referral to-the 900th Hospital of PLA, the pulmonary inflammation had mostly resolved.

Figure 3.

GBM spine metastasis. (A) Enhanced MRI showing tumor invasion at the L1-L2 vertebral level, with a high signal intensity on T2-weighted imaging and uneven enhancement on contrast scans. (B) Postoperative MRI of the lumbar spine showing an in situ thoracolumbar fixation at T12-L1, with a clear spinal canal and no marked compression of the subarachnoid space. (C) Surgically resected lumbar spinal tumor. (D) Hematoxylin and eosin staining showing necrosis and scattered pleomorphic cells, suggesting dissemination of a poorly differentiated GBM (magnification, ×40). GBM, glioblastoma.

Figure 4.

Tumor recurrence 8 months after lumbar spine surgery. (A) Coronal T1-weighted MRI showing recurrent lesion in the right frontal lobe. (B) Coronal T1-weighted MRI demonstrating surrounding edema. (C) Sagittal T1-weighted MRI displaying tumor recurrence along the surgical margin. (D) Sagittal T1-weighted MRI showing adjacent tissue compression. (E) Axial T1-weighted MRI revealing enhanced recurrent lesion. (F) Axial T1-weighted MRI indicating associated mass effect. (G) Axial diffusion-weighted imaging (DWI) showing restricted diffusion in the lesion. (H) Axial DWI confirming high signal intensity consistent with tumor recurrence. The yellow arrows indicate the tumor lesion and the red circles indicate the edema around the tumor.