title: Extracranial glioblastoma with synchronous metastases in the lung, pulmonary lymph nodes, vertebrae, cervical muscles and epidural space in a young patient - case report and review of literature.
abstract: BACKGROUND
  Extraneural and extracranial metastases of glioblastoma (GB) are very rarely reported in the literature. They occur in only 0.2% of all GB patients.
  
  
  METHODS
  We present a 40 year old caucasian male with secondary GB and first diagnosis of an astrocytoma world health organisation (WHO) grade II through stereotactic biopsy in 2006. He presented a new hemiparesis and a progress of the known mass lesion in 2008. Subtotal tumor resection was performed and the histological examination verified a GB. After combined radio- and chemotherapy the adjuvant temozolomide therapy was not started because of non-compliance. In 2011 a second local relapse was resected and 4 month later the patient presented a fast progressing tetraparesis. Cervical CT and MRI scan showed a mass lesion infiltrating the fifth and sixth vertebra with infiltration of the spinal canal and large paravertebral tumor masses. Emergency surgery was performed. By additional screening further metastases were detected in the thoracal and lumbal spine and surprisingly also in the lung and pulmonary lymphnodes. Palliative radio- and chemotherapy of the pulmonal lesions was completed, further antitumor therapy was rejected. The patient died 10 months after diagnosis of the extraneural metastases.
  
  
  CONCLUSIONS
  Especially young "long-term-survivors" seem to have a higher risk of extraneural metastasis from a GB and appropriate staging should be performed in these cases.
authors.affiliation: Department of Neurosurgery, University of Bonn Medical Center, Sigmund-Freud-Str, 25, Bonn 53105, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Blume
authors.forename: Marec
authors.initials: M
authors.lastname: von Lehe
authors.forename: Frank
authors.initials: F
authors.lastname: van Landeghem
authors.forename: Susanne
authors.initials: S
authors.lastname: Greschus
authors.forename: Jan
authors.initials: J
authors.lastname: Boström
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001706:Biopsy; D059186:Chemoradiotherapy, Adjuvant; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004824:Epidural Space / Q000473:pathology*; D017809:Fatal Outcome; D005909:Glioblastoma / Q000556:secondary* / Q000628:therapy; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology*; D008175:Lung Neoplasms / Q000556:secondary* / Q000628:therapy; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D019042:Muscle Neoplasms / Q000556:secondary* / Q000628:therapy; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D019635:Neurosurgical Procedures; D010166:Palliative Care; D010349:Patient Compliance; D013125:Spinal Neoplasms / Q000556:secondary* / Q000628:therapy; D000077204:Temozolomide; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide