Brain Tumor Res Treat.  2022 Jul;10(3):183-189 . 10.14791/btrt.2022.0013.

Leptomeningeal Spread at the Diagnosis of Glioblastoma Multiforme: A Case Report and Literature Review

• Jang C
• Cho BK
• Hwang SH
• Shin HJ
• Yoon SH

• KMID: 2532250
• DOI: http://doi.org/10.14791/btrt.2022.0013

Abstract

Approximately two-thirds of glioblastoma (GBM) patients progress to leptomeningeal spread (LMS) within two years. While 90% of LMS cases are diagnosed during the progression and/or recurrence of GBM (defined as secondary LMS), LMS presentation at the time of GBM diagnosis (defined as primary LMS) is very rare. ¹⁸ F-fluorodeoxy glucose positron emission tomography computed tomography ( ¹⁸F-FDG PET/CT) study helps to diagnose the multifocal spread of the malignant primary brain tumor. Our patient was a 31-year-old man with a tumorous lesion located in the right temporal lobe, a wide area of the leptomeninges, and spinal cord (thoracic 5/6, and lumbar 1 level) involvement as a concurrent manifestation. After the removal of the right temporal tumor, the clinical status progressed rapidly, showing signs of increased intracranial pressure and hydrocephalus caused by LMS. He underwent a ventriculoperitoneal shunt a week after craniotomy. During management, progression of cord compression, paraplegia, bone marrow suppression related to radiochemotherapy, intercurrent infections, and persistent ascites due to peritoneal metastasis of the LMS through the shunt system was observed. The patient finally succumbed to the disease nine months after the diagnosis of simultaneous GBM and LMS. The overall survival of primary LMS with GBM in our case was nine months, which is shorter than that of secondary LMS with GBM. The survival period after the diagnosis of LMS did not seem to be significantly different between primary and secondary LMS. To determine the prognostic effect and difference between primary and secondary LMS, further cooperative studies with large-volume data analysis are warranted.

Keyword

Leptomeningeal spread; Glioblastoma; ¹⁸ F-FDG PET/CT

Figure

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  Fig. 1 Initial contrast enhanced midsagittal MRI reveals prominent leptomeningeal contrast enhancement along the ventral surface of the midbbrain, pons, and medulla oblongata, and dorsal surface of high cervical and medulla (A, white arrows). Coronal view shows right medial temporal lobe round tumor and bilateral basal temporal surface leptomeningeal contrast enhancement (B, white arrows).

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  Fig. 2 Whole-body FDG-PET revealing high metabolic uptake lesions on the left cerebral hemisphere (A, white arrows), right anterior temporal lobe tumor (B, white arrow), and spinal cord of T5/6, L1 spinal level (C and D, white arrows).

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  Fig. 3 Right pterional craniotomy and durotomy exposed the anterior Sylvian fissure and veins with normal-looking cortical surface (A, white arrow). At deep Sylvian fissure yellow coating mass with a friable and finely vascularized surface was observed. The lesion was removed near completely through the anterior Sylvian fissure (B, white arrow).

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  Fig. 4 Histopathologic findings of glioblastoma (Grade 4). The immunohistochemical stain shows positive glial fibrillary acidic protein, and Ki-67 index of more than 30% of tumor cells.(A, ×100; B, ×400). Histological examination of the tumor shows neovascular proliferations and pseudopalisading necrosis (C and D, H&E stain, ×200)

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  Fig. 5 18F-FDG PET/CT exhibited multifocal high metabolic uptake lesions at the abdomen and pelvic bone (arrows) which were considered as abdominopelvic metastasis (spread) of the glioblastoma via ventriculo-peritoneal shunt.

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