J Korean Neurosurg Soc.  2015 Nov;58(5):479-482. 10.3340/jkns.2015.58.5.479.

Glioblastoma Multiforme in the Pineal Region with Leptomeningeal Dissemination and Lumbar Metastasis

• Matsuda R
• Hironaka Y
• Suigimoto
• Nakase H

• KMID: 2191416
• DOI: http://doi.org/10.3340/jkns.2015.58.5.479

Abstract

We report a case of a 31-year-old woman with glioblastoma multiforme (GBM) in the pineal region with associated leptomeningeal dissemination and lumbar metastasis. The patient presented with severe headache and vomiting. Magnetic resonance imaging (MRI) of the brain showed a heterogeneously enhanced tumor in the pineal region with obstructive hydrocephalus. After an urgent ventricular-peritoneal shunt, she was treated by subtotal resection and chemotherapy concomitant with radiotherapy. Two months after surgery, MRI showed no changes in the residual tumor but leptomeningeal dissemination surrounding the brainstem. One month later, she exhibited severe lumbago and bilateral leg pain. Thoracico-lumbar MRI showed drop like metastasis in the lumbar region. Finally she died five months after the initial diagnosis. Neurosurgeons should pay attention to GBM in the pineal region, not only as an important differential diagnosis among the pineal tumors, but due to the aggressive features of leptomeningeal dissemination and spinal metastasis.

Keyword

Glioblastoma multiforme; Pineal region; Leptomeningeal dissemination; Spinal metastasis

MeSH Terms

Adult
Brain
Brain Stem
Diagnosis
Diagnosis, Differential
Drug Therapy
Female
Glioblastoma*
Headache
Humans
Hydrocephalus
Leg
Low Back Pain
Lumbosacral Region
Magnetic Resonance Imaging
Neoplasm Metastasis*
Neoplasm, Residual
Pinealoma
Radiotherapy
Vomiting

Figure

• 

  Fig. 1 Preoperative enhanced magnetic resonance images revealing a heterogenous enhancement of a pineal tumor with obstructive hydrocephalus.

• 

  Fig. 2 Histopathological findings showing the feature of glioblastoma composed of poorly differentiated pleomorphic tumor cells with marked nuclear atypia and brisk mitotic activity and focal necrosis with pseudopalisading (H&E stain ×50).

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  Fig. 3 Postoperative enhanced magnetic resonance images revealing an enhancement surrounding the brainstem and the residual tumor in the pineal region after radiotherapy concomitant chemotherapy.

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  Fig. 4 Thoraco-lumbo-sacral enhanced magnetic resonance images revealing spinal metastasis in the lumbar region (white arrows).

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