title: [Multiple extraneural metastasis of glioblastoma multiforme].
abstract: BACKGROUND
  Glioblastoma multiforme is the most frequent primary tumor in the brain. Despite improvements in its surgical, chemotherapy and radiotherapy treatment, prognosis remains poor. Extracranial metastases of glioblastoma are a rare complication in this disease. Its appearance has been described in lung, liver, bone or lymph nodes.
  
  
  METHODS
  We describe the case of a 20 year-old patient who complained of a subacute-onset headache. In the MRI an enhancing right temporal lesion was detected suggesting a high grade glioma as first diagnosis. Surgery was performed, obtaining a gross total resection of the lesion. Our patient underwent adjuvant radiotherapy and chemotherapy treatment, according to our hospital's protocol. Five months after initial surgery our patient complained of chest pain and a hacking cough. A thoracic-abdominal-pelvic CT scan was obtained, which showed bilateral lung infiltrates with pleural effusion, a pancreatic nodule and several vertebral lytic lesions. The lung lesions were biopsied. The pathologic diagnosis was metastatic glioblastoma multiforme. The patient died eight months after initial diagnosis.
  
  
  CONCLUSIONS
  Extracranial metastases of glioblastoma remain a rare event although its incidence is increasing, probably due to the improvement in survival among these patients and better imaging techniques. The mechanisms for extracranial dissemination of glioblastoma are not entirely known, as several theories exist in this regard. Physicians must be aware of this complication and keep it in mind as a differential diagnosis to improve the quality of life of our patients.
authors.affiliation: Servicio de Neurocirugía, Hospital Universitario Donostia, San Sebastián, 20080, Spain. joseundabeitia@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Undabeitia
authors.forename: M
authors.initials: M
authors.lastname: Castle
authors.forename: M
authors.initials: M
authors.lastname: Arrazola
authors.forename: C
authors.initials: C
authors.lastname: Pendleton
authors.forename: I
authors.initials: I
authors.lastname: Ruiz
authors.forename: E
authors.initials: E
authors.lastname: Úrculo
mesh_terms: D001932:Brain Neoplasms / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D005909:Glioblastoma / Q000556:secondary*; D006801:Humans; D055815:Young Adult