Case report
Distant spread of a supratentorial glioblastoma to the spinal cord

https://doi.org/10.1016/j.jocn.2016.11.010Get rights and content

Highlights

  • Extracranial spread from a glioblastoma is exceedingly rare.

  • Spread can be along white matter tracts, leptomeningeal or haematogenous.

  • It is important to consider when there are symptoms referrable to the spinal cord.

  • Spread along the neuraxis can be confirmed by genetic analysis.

Abstract

Extracranial spread from a glioblastoma is rare. We present a case of a 48 year-old man with a previously radiologically-stable left temporal lobe glioblastoma presenting with symptoms referrable to the spinal cord. MRI revealed a spinal cord lesion, with the differential including transverse myelitis and tumour. Open surgical biopsy revealed high-grade astrocytoma. Genetic analysis of both the supratentorial and spinal tumours revealed R132H IDH1 mutations, providing evidence that the spinal cord lesion had spread from the supratentorial tumour.

Introduction

Glioblastomas are aggressive tumours with a poor prognosis. Although highly infiltrative tumours, they rarely spread beyond the brain. Here, we report the case of extra-cranial spread to the spinal cord from a previously well-controlled glioblastoma.

Section snippets

Case report

A 48 year-old male presented with a 5–6 week history of progressively decreasing lower limb sensation, urinary retention and gait disturbance. He had a known radiologically-stable left temporal lobe glioblastoma, which had been debulked three years prior, and was receiving bevacizumab chemotherapy at the time. Neurological exam showed normal tone and power in both lower limbs, but markedly diminished sensation to light touch on the left; patellar and Achilles reflexes were concomitantly

Discussion

Unlike their intracranial counterparts, spinal cord gliomas have not been associated with IDH1 mutations [2]. As such, the presence of IDH1 mutations in both masses allows us to confidently conclude that the spinal lesion has spread from the temporal lobe glioblastoma, despite this being a rare phenomenon. The pathway of extra-cranial spread can be leptomeningeal, along white matter tracts or haematogenous. Leptomeningeal spread of glioblastoma is rarely clinically apparent [3], [4], though

Conclusions

Symptomatic spinal cord spread is a rare complication of glioblastoma, but an important differential to be considered in the context of symptoms referrable to the spinal cord, especially in patients with longer survival.

Disclosure/conflicts of interest

None.

References (7)

There are more references available in the full text version of this article.

Cited by (0)

View full text