J Korean Med Sci.  2004 Dec;19(6):911-914. 10.3346/jkms.2004.19.6.911.

Metastatic Glioblastoma in Cervical Lymph Node after Repeated Craniotomies: Report of a Case with Diagnosis by Fine Needle Aspiration

• Moon KS
• Jung S
• Lee MC
• Kim IY
• Kim HW
• Lee JK
• Kim TS

• KMID: 1778581
• DOI: http://doi.org/10.3346/jkms.2004.19.6.911

Abstract

Head and neck metastasis from glioblastoma is rare event usually seen in patients with previous and repeated surgery. We present the case of a 35 yr-old-female suffering from metastatic glioblastoma in cervical lymph node that was diagnosed by fine needle aspiration. During the last 4 yr, she had four separate craniotomies for the recurrent brain tumors. Cytological diagnosis was made by light microscopy with immunostaining with glial fibrillay acid protein. Chemotherapy with vincristine and procarbazine was performed. The cervical masses were decreased in size and some disappeared while the intracranial glioblastoma continued to grow during chemotherapy. We discuss possible explanations for these different courses after chemotherapy in extraneural metastatic glioblastoma and primary intracranial glioblastoma.

Keyword

Drug Therapy; Glioblastoma; Lymph Nodes; Neoplasm Metastasis

MeSH Terms

Adult
Antineoplastic Agents/therapeutic use
Brain Neoplasms/drug therapy/*surgery
Craniotomy
Female
Glioblastoma/drug therapy/*pathology/*secondary
Humans
Lymph Nodes/*pathology
Lymphatic Metastasis
Neck
Neoplasm Recurrence, Local/drug therapy/pathology/surgery

Figure

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  Fig. 1 Radiologic findings. (A) Gd-enhanced axial T1-weighted MR images before first operation demonstrate a ring-enhanced mass in the left parietal region. (B, C) Gd-enhanced axial T1-weighted MR images show leptomeningeal spread of tumor, and subcutaneous scalp masses that are in continuity with the intracranial mass through the burr hole.

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  Fig. 2 Radiologic findings. (A, B) Gd-enhanced coronal T1-weighted MR images of the brain show multiple lymph adenopathies in deep cervical area (arrows). These lymph adenopathies are separated from extended scalp masses.

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  Fig. 3 Pathologic findings of intracranial glioblastoma. (A, B) Biopsy specimen taken from the last surgery confirms as glioblastoma that had variable histologic features, mitosis, endothelial proliferation and necrosis (A; H&E, ×40: B; H&E, ×400). (C) Immunohistochemical stain demonstrates positive immunoreactivity for GFAP (GFAP immunostain, ×200).

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  Fig. 4 Fine needle aspiration smear from metastatic glioblastoma in cervical lymph node. (A) Photomicrograph reveals small atypical cells infiltrated into the fibroadipose tissue in cervical soft tissue (H&E, ×200). (B) Immunohistochemical stain demonstrates positive immunoreactivity for GFAP (GFAP immunostain, ×400).

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