title: Biologic characterization of a secondary glioblastoma with extracranial progression and systemic metastasis.
abstract: Glioblastomas rarely metastasize outside the CNS. We biologically characterized a case of secondary glioblastoma associated with extracranial progression and distant metastasis. A 42-year-old male patient was subjected to craniotomy for a left temporal tumor (astrocytoma grade II) and subsequently underwent another 3 craniotomies due to tumor recurrences. At the third craniotomy, extracranial progression was noted, and the tumor was classified as a glioblastoma. In order to pinpoint the genes expressed differentially in the intracranial primary tumor and the metastatic tumors, we used cDNA microarray. The patterns of gene expression in these 2 samples were highly similar, suggesting that the mechanism of metastasis was direct infiltration of tumor cells into extracranial blood vessels. Insulin-like growth factor binding protein-2 was overexpressed in both primary and metastatic tumors. Immunohistochemical studies of DNA-dependent protein kinase, which participates in the repair of DNA, was strongly positive in the samples obtained at the first and second operations, but the positive rates were markedly reduced in the specimens obtained at the third and fourth operations. These results suggest that insulin-like growth factor binding protein-2 and deficiency of DNA-dependent protein kinase proteins promoted tumor progression in the present case.
authors.affiliation: Department of Neurosurgery, Saga Medical School, 5-1-1 Nabeshima, Saga 849-8501, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Ueda
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Mineta
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Furuta
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shiraishi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tabuchi
mesh_terms: D000328:Adult; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000235:genetics / Q000556:secondary*; D006801:Humans; D008297:Male; D020411:Oligonucleotide Array Sequence Analysis / Q000706:statistics & numerical data; D011859:Radiography