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Intramedullary spinal glioblastoma metastasis from anaplastic astrocytoma of cerebellum: A case report and review of the literature.

Kuo KL, Lieu AS, Tsai FJ, Chen YT, Liang PI - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: We then performed laminectomy and tumor biopsy.After reviewing the English literature to date, most metastatic spinal glioblastoma resulted from previous intracranial glioblastoma, and there are few studies mentioning spinal glioblastoma originating from intracranial low-grade gliomas.Over time, improvement in local control of the primary tumor has raised patient risk of the possibility of spinal metastasis, and clinical physicians should be aware of this aspect so that quicker diagnosis and management will be accomplished, even in patients with lower grade of intracranial gliomas.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

ABSTRACT
Cerebellar anaplastic astrocytoma is infrequently encountered even nowadays, and drop metastasis with progression into spinal glioblastoma is not reported in the English literature. We report a case of cerebellar anaplastic astrocytoma receiving operation and subsequent concurrent chemoradiotherapy. One year later, progressive weakness of both lower limbs and unsteady gait occurred. Spine magnetic resonance imaging showed cervical and thoracic spine intramedullary tumor. We then performed laminectomy and tumor biopsy. The histopathological report demonstrated primary spinal cord glioblastoma multiforme with positive glial fibrillary acidic protein, high MIB-1 labeling index and negative staining of isocitrate dehydrogenase-1 mutation. After reviewing the English literature to date, most metastatic spinal glioblastoma resulted from previous intracranial glioblastoma, and there are few studies mentioning spinal glioblastoma originating from intracranial low-grade gliomas. Over time, improvement in local control of the primary tumor has raised patient risk of the possibility of spinal metastasis, and clinical physicians should be aware of this aspect so that quicker diagnosis and management will be accomplished, even in patients with lower grade of intracranial gliomas.

No MeSH data available.


Related in: MedlinePlus

Permanent pathology of cerebellar anaplastic astrocytoma. (a and b) The low-power image displays hypercellularity of neoplastic cells, (c) The high-power image shows tumor cells featuring hyperchromatic, nuclear pleomorphism and increased mitotic activity. Atypical mitosis is also identified, (d-h) These tumor cells are immunoreactive for glial fibrillary acidic protein, epidermal growth factor receptor and p53 but negative for isocitrate dehydrogenase-1 and synaptophysin. The Ki-67 labeling index is about 5–10%
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Figure 2: Permanent pathology of cerebellar anaplastic astrocytoma. (a and b) The low-power image displays hypercellularity of neoplastic cells, (c) The high-power image shows tumor cells featuring hyperchromatic, nuclear pleomorphism and increased mitotic activity. Atypical mitosis is also identified, (d-h) These tumor cells are immunoreactive for glial fibrillary acidic protein, epidermal growth factor receptor and p53 but negative for isocitrate dehydrogenase-1 and synaptophysin. The Ki-67 labeling index is about 5–10%

Mentions: A 27-year-old male patient without systemic disease came to our clinic owing to progressive unsteady gait. Magnetic resonance imaging (MRI) showed cerebellar mass lesion in the 4th ventricle and obstructive hydrocephalus [Figure 1a]. After brain tumor removal, pathological diagnosis showed anaplastic astrocytoma. After concurrent chemoradiotherapy (CCRT), he was followed up in our neurosurgical clinic. One year later, he returned owing to progressive unsteady gait, urine and stool incontinence and progressive lower limbs weakness, with numbness and paresthesia sensation below the T7-T8 levels. Cervical to thoracic spine and lumbar MRI showed diffusely infiltrating intradural intramedullary tumor over the level of C5-6, T2-6, T9-10, and L1-2 levels with leptomeningeal metastasis [Figure 1c]. After decompressive laminectomy of T2-6, T9-10, and L1-2 level, we incised the dura and the arachnoid membrane, and an intradural intramedullary tumor was seen without infiltration to the dura. The tumor is centrally located within the spinal cord, and we approached the tumor from the midline posteriorly. Spinal tumor biopsy of both thoracic and lumbar part was then performed, and the patient remained paraplegic with incontinence postoperatively. Spinal glioblastoma was the final diagnosis, and from both thoracic and the lumbar parts, showed typical features of glioblastoma inclusive of nuclear atypia, high mitotic index, necrosis and microvascular proliferation. IHC study showed positive glial fibrillary acidic protein (GFAP), high Ki-67 labeling index (30%), positive tumor protein p53 (TP53) mutation and negative finding of isocitrate dehydrogenase-1 (IDH-1), compared to the brain anaplastic astrocytoma [Figures 2 and 3].


Intramedullary spinal glioblastoma metastasis from anaplastic astrocytoma of cerebellum: A case report and review of the literature.

Kuo KL, Lieu AS, Tsai FJ, Chen YT, Liang PI - Asian J Neurosurg (2015 Jul-Sep)

Permanent pathology of cerebellar anaplastic astrocytoma. (a and b) The low-power image displays hypercellularity of neoplastic cells, (c) The high-power image shows tumor cells featuring hyperchromatic, nuclear pleomorphism and increased mitotic activity. Atypical mitosis is also identified, (d-h) These tumor cells are immunoreactive for glial fibrillary acidic protein, epidermal growth factor receptor and p53 but negative for isocitrate dehydrogenase-1 and synaptophysin. The Ki-67 labeling index is about 5–10%
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553752&req=5

Figure 2: Permanent pathology of cerebellar anaplastic astrocytoma. (a and b) The low-power image displays hypercellularity of neoplastic cells, (c) The high-power image shows tumor cells featuring hyperchromatic, nuclear pleomorphism and increased mitotic activity. Atypical mitosis is also identified, (d-h) These tumor cells are immunoreactive for glial fibrillary acidic protein, epidermal growth factor receptor and p53 but negative for isocitrate dehydrogenase-1 and synaptophysin. The Ki-67 labeling index is about 5–10%
Mentions: A 27-year-old male patient without systemic disease came to our clinic owing to progressive unsteady gait. Magnetic resonance imaging (MRI) showed cerebellar mass lesion in the 4th ventricle and obstructive hydrocephalus [Figure 1a]. After brain tumor removal, pathological diagnosis showed anaplastic astrocytoma. After concurrent chemoradiotherapy (CCRT), he was followed up in our neurosurgical clinic. One year later, he returned owing to progressive unsteady gait, urine and stool incontinence and progressive lower limbs weakness, with numbness and paresthesia sensation below the T7-T8 levels. Cervical to thoracic spine and lumbar MRI showed diffusely infiltrating intradural intramedullary tumor over the level of C5-6, T2-6, T9-10, and L1-2 levels with leptomeningeal metastasis [Figure 1c]. After decompressive laminectomy of T2-6, T9-10, and L1-2 level, we incised the dura and the arachnoid membrane, and an intradural intramedullary tumor was seen without infiltration to the dura. The tumor is centrally located within the spinal cord, and we approached the tumor from the midline posteriorly. Spinal tumor biopsy of both thoracic and lumbar part was then performed, and the patient remained paraplegic with incontinence postoperatively. Spinal glioblastoma was the final diagnosis, and from both thoracic and the lumbar parts, showed typical features of glioblastoma inclusive of nuclear atypia, high mitotic index, necrosis and microvascular proliferation. IHC study showed positive glial fibrillary acidic protein (GFAP), high Ki-67 labeling index (30%), positive tumor protein p53 (TP53) mutation and negative finding of isocitrate dehydrogenase-1 (IDH-1), compared to the brain anaplastic astrocytoma [Figures 2 and 3].

Bottom Line: We then performed laminectomy and tumor biopsy.After reviewing the English literature to date, most metastatic spinal glioblastoma resulted from previous intracranial glioblastoma, and there are few studies mentioning spinal glioblastoma originating from intracranial low-grade gliomas.Over time, improvement in local control of the primary tumor has raised patient risk of the possibility of spinal metastasis, and clinical physicians should be aware of this aspect so that quicker diagnosis and management will be accomplished, even in patients with lower grade of intracranial gliomas.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan ; Department of Medicine, Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

ABSTRACT
Cerebellar anaplastic astrocytoma is infrequently encountered even nowadays, and drop metastasis with progression into spinal glioblastoma is not reported in the English literature. We report a case of cerebellar anaplastic astrocytoma receiving operation and subsequent concurrent chemoradiotherapy. One year later, progressive weakness of both lower limbs and unsteady gait occurred. Spine magnetic resonance imaging showed cervical and thoracic spine intramedullary tumor. We then performed laminectomy and tumor biopsy. The histopathological report demonstrated primary spinal cord glioblastoma multiforme with positive glial fibrillary acidic protein, high MIB-1 labeling index and negative staining of isocitrate dehydrogenase-1 mutation. After reviewing the English literature to date, most metastatic spinal glioblastoma resulted from previous intracranial glioblastoma, and there are few studies mentioning spinal glioblastoma originating from intracranial low-grade gliomas. Over time, improvement in local control of the primary tumor has raised patient risk of the possibility of spinal metastasis, and clinical physicians should be aware of this aspect so that quicker diagnosis and management will be accomplished, even in patients with lower grade of intracranial gliomas.

No MeSH data available.


Related in: MedlinePlus