Brain Tumor Res Treat.  2019 Apr;7(1):39-43. 10.14791/btrt.2019.7.e24.

Extensive Pachymeningeal Dissemination of Glioblastoma Mimicking Chronic Subdural Hematoma: A Case Report

• Lee J
• Kim MS
• Kim YZ

• KMID: 2444794
• DOI: http://doi.org/10.14791/btrt.2019.7.e24

Abstract

Meningeal dissemination (MDS) of glioblastoma is rare, although its incidence might have been underestimated. MDS of glioblastoma has a fatal course. Thus, rapid and precise diagnosis of MDS is important for further palliative treatment. Unfortunately, MDS of glioblastoma could be diagnosed at a delayed time, causing failure to treat patient optimally. Herein, we present a case of a 56-year-old male with MDS of glioblastoma mimicking chronic subdural hemorrhage (CSDH) after head trauma due to slip down. During treatment for CSDH, MDS of glioblastoma was not controlled appropriately. The patient succumbed to MDS of glioblastoma at 9 weeks after the date of diagnosis of CSDH which could be an MDS.

Keyword

Glioblastoma; Gliosarcoma; Meningeal dissemination; Mortality

MeSH Terms

Craniocerebral Trauma
Diagnosis
Glioblastoma*
Gliosarcoma
Hematoma, Subdural
Hematoma, Subdural, Chronic*
Humans
Incidence
Male
Middle Aged
Mortality
Palliative Care

Figure

• 

  Fig. 1 The second MR image at the time of occurrence of progressive hemiparesis on the left side showing increased size of the previous area with high signal intensity in fluid attenuated inversion recovery image (A), and nodular rim enhancement at size of 1 cm×1 cm showing in T1WI axial (B) coronal (C), and sagittal images (D) in the right frontoparietal area.

• 

  Fig. 2 MR image for regular follow-up showing more extensive peritumoral edema in the fluid attenuated inversion recovery image (A), the low signal intensity suggesting necrosis, irregular shaped unevenly thicken walled mass with internal necrosis, and heterogeneous enhancement on axial (B), coronal (C), and sagittal images (D) in the right frontoparietal area.

• 

  Fig. 3 Histopathological features showing two biphasic patterns in tumor of epithelioid glial component (upper lane) and cellular spindle mesenchymal component (bottom lane); (H&E staining, ×20) (A). The glial component surrounded by elongated mesenchymal component and the glial area is composed of mild pleomorphic astrocyte (H&E staining, ×20) (B), leading to the diagnosis of gliosarcoma. Immunohistochemistry for GFAP demonstrates positivity in glial component (×20) (C), and the biphasic pattern shows strong reticulin positivity in mesenchymal areas with reticulin negative glial areas (reticulin stain, ×20) (D). H&E: hematoxylin and eosin.

• 

  Fig. 4 The noncontrast CT scan showing a newly developed subdural fluid collection which is suggestive hematoma at the right hemisphere (A). Repeated CT scan without contrast showing the lining pattern of soft tissue density as well as fluid collection at the right hemisphere (B). Intraoperative findings (C) show that thickened dura matter with attachment of the tumors (➀), whitish colored tumor with a fragile texture and relatively poor vascularity (➁), and the relatively well preserved arachnoid membrane beneath the tumor without destruction nor invasion by the tumor (➂).

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