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P01.134 Extracranial spread of glioblastoma as the initial manifestation of the disease: case report and literature review

2018; Oxford University Press; Volume: 20; Issue: suppl_3 Linguagem: Inglês

10.1093/neuonc/noy139.176

1523-5866

Carla Domingos, J. Rato, Olinda Rebelo, Hermínio Tão,

Cancer, Hypoxia, and Metabolism

Glioblastomas are the most frequent and most aggressive primary brain tumors, representing one of the main causes of morbidity and mortality in neurosurgical practice. At the time of diagnosis the spread of these tumors is described as locally invasive, with penetration through the dura mater and invasion of extracranial structures rarely occurring (less than 2% of the cases). The authours describe a case of a brain tumour in a right handed 63-year-old woman complaining with headaches, dysarthria and paresthesia involving left V2 territory. Enhanced MRI showed a solid lesion involving Meckel’s cavum and transdural spread through foramen ovale invading extracranial structures, and a large cystic component compressing left temporal lobe with surrounding vasogenic edema, initially interpreted as a giant trigeminal neurinoma with cystic component. Pre and post-operatory imaging features of the tumor are showed. The patient underwent surgery with removal of both solid and cystic components. After surgery she improved from headache and dysarthria, maintaining discrete paresthesia in the aforementioned trigeminal territory after surgery. Histopathological examination showed cells of variable dimensions with nuclear atypia and abundant mitoses. There were hypercellular areas with elongated cells forming bundles between collagen and reticulin fibers, with necrosis phenomena, vascular microproliferation and leptomeningeal infiltration. The tumor showed intense positivity for the glial fibrillary acidic protein (GFAP) and negativity for the mutation of isocitrate dehydrogenase 1 (IDH1). Final histopathological diagnosis was wild type glioblastoma with meningeal invasion (WHO grade IV). Histological images of the tumor are showed. After surgery patient was referred to adjuvant therapies. Extradural spread of glioblastomas occurs late in the course of the disease (on average 2 years after diagnosis), usually after craniotomies performed for excision of the lesion. However primary extradural spread of these tumors at the time of diagnosis is a rare phenomenon, with few cases being reported in the literature. The authors reviewed the literature reported cases and summarized the three pathways of dissemination at the moment of diagnosis: 1) by direct erosion of the dura mater; 2) through peri-vascular spaces or peri-neural sheaths of cranial or spinal nerves; 3) through dural slits in temporal fossa created by intracranial hypertension due to large volume tumours.