gms | German Medical Science

Objective: Metastases from glioblastoma outside the CNS may be rare due to the short life expectancy of patients with glioblastoma or because of the effects of structural differences between brain tissue and other tissues in the body. But lymphatic spread with lymph node metastases is described as well as a supposed generalization via the blood system. Metastases from glioblastoma are likely to become a more common problem as the local control of primary glioblastoma improves.

Methods: A 40-year-old woman with a right frontal glioblastoma multiforme was initially treated with an external drainage, which was inserted through a right coronal burr hole into a tumour cyst. Surgical excision, radiotherapy and temodal therapy followed. One and a half year later the patient had two rapidly growing tumours of the scalp. These two lesions were excised, and histological findings revealed cutaneous metastases of glioblastoma. The histomorphology of the intracutaneous tumours was broadly the same as in the primary intracerebral neoplasia. GFAP was expressed intensively in the cellular processes and in the perinuclear cytoplasmatic rim of most tumour cells both, in the brain and in the skin.

Results: In the only case with a cutaneous scalp metastasis of a glioblastoma reported so far, similarly to our patient, a ventricular access device into a cyst of the tumour was placed, so that in both cases the spread of tumour cells obviously occurred after the tumour cyst was punctured. Because of the metastases' only occurrence in the scalp a generalization via the blood system is not probable.

Conclusions: Different paths of generalization of glioblastoma multiforme are possible. Even after a long time period scalp metastases can develop after percutaneous puncture of a glioblastoma.