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Antiangiogenic Therapies and Extracranial Metastasis in Glioblastoma: A Case Report and Review of the Literature.

Khattab MH, Marciscano AE, Lo SS, Lim M, Laterra JJ, Kleinberg LR, Redmond KJ - Case Rep Oncol Med (2015)

Bottom Line: We present a case report of a patient with glioblastoma multiforme (GBM) complicated by extracranial metastasis (ECM) whose survival of nearly four years surpassed the anticipated life expectancy given numerous negative prognostic factors including EGFRvIII-mutation, unmethylated MGMT promoter status, and ECM.Interestingly, while this patient suffered from locally aggressive disease with multiple intracranial recurrences, the proximal cause of death was progressive extracranial disease and complications related to pulmonary metastases.Herein, we review potential mechanisms of ECM with an emphasis upon glioblastoma molecular and genetic profiles and the potential implications of targeted agents such as bevacizumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University, 401 North Broadway, Suite 1440, Baltimore, MD 21231-5678, USA.

ABSTRACT
We present a case report of a patient with glioblastoma multiforme (GBM) complicated by extracranial metastasis (ECM) whose survival of nearly four years surpassed the anticipated life expectancy given numerous negative prognostic factors including EGFRvIII-mutation, unmethylated MGMT promoter status, and ECM. Interestingly, while this patient suffered from locally aggressive disease with multiple intracranial recurrences, the proximal cause of death was progressive extracranial disease and complications related to pulmonary metastases. Herein, we review potential mechanisms of ECM with an emphasis upon glioblastoma molecular and genetic profiles and the potential implications of targeted agents such as bevacizumab.

No MeSH data available.


Related in: MedlinePlus

(a) Whole body FDG PET imaging demonstrating hypermetabolic osseous and visceral metastases including bilateral pulmonary nodules and hilar adenopathy. (b) CT imaging demonstrating mediastinal adenopathy, multiple pulmonary nodules, and right pleural effusion. (c) Coregistered PET/CT imaging demonstrating intense FDG uptake within GBM lung metastases.
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fig2: (a) Whole body FDG PET imaging demonstrating hypermetabolic osseous and visceral metastases including bilateral pulmonary nodules and hilar adenopathy. (b) CT imaging demonstrating mediastinal adenopathy, multiple pulmonary nodules, and right pleural effusion. (c) Coregistered PET/CT imaging demonstrating intense FDG uptake within GBM lung metastases.

Mentions: The patient developed back pain and abdominal discomfort approximately 40 months following initial diagnosis and 3 months following reinitiation of bevacizumab therapy. CT imaging of the chest demonstrated multiple pulmonary nodules, including a 2.5 cm right middle lobe nodule and a 1.2 cm left lower lobe nodule along with bilateral hilar adenopathy. A staging fluorodeoxyglucose positron emission tomography (FDG PET) scan noted abnormal uptake within several right hilar lymph nodes and diffuse osseous FDG uptake within the sternum, thoracic, lumbar, and pelvic bones. The pulmonary nodules identified on CT imaging were also found to be FDG-avid, right middle lobe (SUV 11.5), two left upper lobe nodules (SUV 6.4 and 5.1), and right upper lobe (SUV 5.0) (Figure 2). Flexible bronchoscopy with biopsy was performed and demonstrated malignant spindle cell tumors with geographic necrosis consistent with metastatic GBM. The tumor cells were positive for GFAP, weakly positive for S100, and negative for synaptophysin, EMA, HHV-8, HMB-45, desmin, CD34, keratin, chromogranin, and CD117. MIB-1 proliferative index was approximately 40%. AFB and GMS stains were negative.


Antiangiogenic Therapies and Extracranial Metastasis in Glioblastoma: A Case Report and Review of the Literature.

Khattab MH, Marciscano AE, Lo SS, Lim M, Laterra JJ, Kleinberg LR, Redmond KJ - Case Rep Oncol Med (2015)

(a) Whole body FDG PET imaging demonstrating hypermetabolic osseous and visceral metastases including bilateral pulmonary nodules and hilar adenopathy. (b) CT imaging demonstrating mediastinal adenopathy, multiple pulmonary nodules, and right pleural effusion. (c) Coregistered PET/CT imaging demonstrating intense FDG uptake within GBM lung metastases.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493308&req=5

fig2: (a) Whole body FDG PET imaging demonstrating hypermetabolic osseous and visceral metastases including bilateral pulmonary nodules and hilar adenopathy. (b) CT imaging demonstrating mediastinal adenopathy, multiple pulmonary nodules, and right pleural effusion. (c) Coregistered PET/CT imaging demonstrating intense FDG uptake within GBM lung metastases.
Mentions: The patient developed back pain and abdominal discomfort approximately 40 months following initial diagnosis and 3 months following reinitiation of bevacizumab therapy. CT imaging of the chest demonstrated multiple pulmonary nodules, including a 2.5 cm right middle lobe nodule and a 1.2 cm left lower lobe nodule along with bilateral hilar adenopathy. A staging fluorodeoxyglucose positron emission tomography (FDG PET) scan noted abnormal uptake within several right hilar lymph nodes and diffuse osseous FDG uptake within the sternum, thoracic, lumbar, and pelvic bones. The pulmonary nodules identified on CT imaging were also found to be FDG-avid, right middle lobe (SUV 11.5), two left upper lobe nodules (SUV 6.4 and 5.1), and right upper lobe (SUV 5.0) (Figure 2). Flexible bronchoscopy with biopsy was performed and demonstrated malignant spindle cell tumors with geographic necrosis consistent with metastatic GBM. The tumor cells were positive for GFAP, weakly positive for S100, and negative for synaptophysin, EMA, HHV-8, HMB-45, desmin, CD34, keratin, chromogranin, and CD117. MIB-1 proliferative index was approximately 40%. AFB and GMS stains were negative.

Bottom Line: We present a case report of a patient with glioblastoma multiforme (GBM) complicated by extracranial metastasis (ECM) whose survival of nearly four years surpassed the anticipated life expectancy given numerous negative prognostic factors including EGFRvIII-mutation, unmethylated MGMT promoter status, and ECM.Interestingly, while this patient suffered from locally aggressive disease with multiple intracranial recurrences, the proximal cause of death was progressive extracranial disease and complications related to pulmonary metastases.Herein, we review potential mechanisms of ECM with an emphasis upon glioblastoma molecular and genetic profiles and the potential implications of targeted agents such as bevacizumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University, 401 North Broadway, Suite 1440, Baltimore, MD 21231-5678, USA.

ABSTRACT
We present a case report of a patient with glioblastoma multiforme (GBM) complicated by extracranial metastasis (ECM) whose survival of nearly four years surpassed the anticipated life expectancy given numerous negative prognostic factors including EGFRvIII-mutation, unmethylated MGMT promoter status, and ECM. Interestingly, while this patient suffered from locally aggressive disease with multiple intracranial recurrences, the proximal cause of death was progressive extracranial disease and complications related to pulmonary metastases. Herein, we review potential mechanisms of ECM with an emphasis upon glioblastoma molecular and genetic profiles and the potential implications of targeted agents such as bevacizumab.

No MeSH data available.


Related in: MedlinePlus