J Korean Neurosurg Soc.  2012 Mar;51(3):147-150. 10.3340/jkns.2012.51.3.147.

Extraneural Metastasis of Glioblastoma Multiforme Presenting as an Unusual Neck Mass

• Seo YJ
• Cho WH
• Kang DW
• Cha SH

• KMID: 2018188
• DOI: http://doi.org/10.3340/jkns.2012.51.3.147

Abstract

Glioblastoma multiforme (GBM) is the most aggressive intracranial tumor and it commonly spreads by direct extension and infiltration into the adjacent brain tissue and along the white matter tract. The metastatic spread of GBM outside of the central nervous system (CNS) is rare. The possible mechanisms of extraneural metastasis of the GBM have been suggested. They include the lymphatic spread, the venous invasion and the direct invasion through dura and bone. We experienced a 46-year-old man who had extraneural metastasis of the GBM on his left neck. The patient was treated with surgery for 5 times, radiotherapy and chemotherapy. He had survived 6 years since first diagnosed. Although the exact mechanism of the extraneural metastasis is not well understood, this present case shows the possibility of extraneural metastasis of the GBM, especially in patients with long survival.

Keyword

Glioblastoma multiforme; Extraneural metastasis; Neck mass

MeSH Terms

Brain
Central Nervous System
Glioblastoma
Humans
Middle Aged
Neck
Neoplasm Metastasis

Figure

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  Fig. 1 Preoperative gadolinium enhanced T1-weighted magnetic resonance image (MRI) demonstrates a mass lesion with peripheral irregular well enhancement in the left parietal region (A). Preoperative T2-weighted coronal MRI (B) and computed tomography scan (C) show bony defect (arrow) suggesting previous craniotomy near the mass lesion.

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  Fig. 2 Histologic findings after first operation show pleomorphic astrocytic tumor cells with mitosis and nuclear atypia (hematoxylin-eosin, original magnification, ×400).

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  Fig. 3 Contrast enhanced magnetic resonance images taken 2 weeks after the first surgery shows remnant mass lesion in the parietal region.

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  Fig. 4 A : Three-year follow up contrast enhanced magnetic resonance image shows increased enhancing mass of the left parietal lobe. B : The neck CT scan with contrast enhancement reveals new peripheral enhancing lesion with lymph node enlargement in the left neck. CT : computed tomography.

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  Fig. 5 Pathological specimen from the neck reveals increased cellularity, with blood vessel proliferation and necrosis (hematoxylin-eosin, original magnification, ×400).

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