Epithelioid Glioblastoma with Leptomeningeal Gliomatosis - Case Report and Review of the Literature
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 10, Issue 2
Abstract
Glioblastomas tend to be morphologically diverse. Although rare, pseudoepithelial components (adenoid or epithelioid) can be a diagnostic challenge. We describe a case of a 47-year-old female patient initially complaining of neck pain and dizziness. On neurological examination, an unsteady gait and memory disturbances were noted. MRI showed a contrast-enhancing lesion in the left temporal lobe without significant edema, suggesting the presence of cerebral metastasis. After complete resection of the tumor (as verified by early post-op MRI), the patient made an uneventful recovery. Based on extensive histopathological analyses, the tumor was diagnosed as epithelioid glioblastoma (E-GBM). Two months after concomitant radiation and chemotherapy, the patient developed severe neck pain, became dizzy and was confused. CSF examination confirmed tumor cells, and MRI of the spine showed diffuse dural contrast enhancement, suggesting extensive leptomeningeal spread. The patient passed away four months after the initial diagnosis. E-GBMs represent one of the least prevalent morphologic subtypes of glioblastoma. Although E-GBMs are difficult to detect and often do not present as high-grade gliomas, clinicians should be aware of the unusual patterns of these GBMs. E-GBM should be considered in the case of MRI findings without peripheral edema, and when newly diagnosed intracerebral masses arise without a known primary. In addition, we discuss our case in terms of previous reports on this condition.Glioblastomas are the highest-grade malignant brain tumors within the spectrum of astrocytic neoplasms [1,2]. A very uncommon morphologic variation is glioblastomas with epithelial or pseudoepithelial (adenoid or epithelioid) features. Epithelioid glioblastomas (E-GBMs) are a rare subtype characterized by a cohesive architectural organization in epithelioid nests and sheets. This phenotype can obscure the glial lineage and may mimic metastatic involvement of non-CNS neoplasms because of epithelial-like characteristics [1,3-5]; thus, E-GBMs remain a considerable diagnostic challenge. Many reports have described these unusual glioblastomas as solitary lesions [6,7]. However, Gasco et al. reported the first case of a multifocal E-GBM that resembled cerebral metastasis [6]. In the present work, we describe an unusual occurrence of an E-GBM with leptomeningeal gliomatosis and discuss it in terms of the available literature.
Authors and Affiliations
Walid Albanna, Gerrit A Schubert, Hans Clusmann, Sonny K Tan, Peter Schmiegelow, Ralf M Buhl
Keywords
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- EP ID EP591865
- DOI 10.26717/BJSTR.2018.10.001920
- Views 198
- Downloads 0
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