Artikel
20 cases of symptomatic spinal metastases of intracranial glioblastoma – clinical characteristics and pathomechanism depending on GFAP expression
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Autoren
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H. Maslehaty
- Klinik für Neurochirurgie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel
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S. Cordovi
- Kantonsspital Aarau, Department of Pathology
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M. Hefti
- Kantonsspital Aarau, Department of Neurosurgery
| Veröffentlicht: | 20. Mai 2009 |
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Gliederung
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Objective: Spinal spreading of intracranial glioblastoma (GBM) remains asymptomatic in the majority of cases. We illustrate different spreading mechanisms depending on astrocytic GBM cell differentiation by presenting an extraordinary case of a 47-year-old patient with rapid progressive paraplegia due to coincident intramedullary and leptomeningeal dissemination (ILD) of a supratentorial GBM and the review of 20 cases of intracranial GBM with symptomatic spinal spreading.
Material and methods: Histological examination and immunohistochemical assessment of GFAP expression of tissues of the intracranial, leptomeningeal and intramedullary tumors was done. A search of the literature with “glioblastoma spinal metastases” in MEDLINE was performed and the results separated into 19 cases of symptomatic spinal dissemination of an initially intracranial GBM in patients older than 16 years.
Results: GBM has been verified in all tissues by histological examination. GFAP expression was high in intracranial and intramedullary tumors while low in leptomeningeal dissemination.
Mean patient age was calculated to be 45 years (range 18 to 67 years). Male to female ratio 1.9:1; the mean interval between the identification of ILD to death was found to be 4.5 months (Range 1 to 24 months). Overall survival time (OST) showed a mean of 18.6 months (Range 7 – 62 months). Symptomatic spinal metastases were localized in the leptomeninges in 14 cases and within the medulla in 7 cases. Simultaneous occurrence of intramedullary and leptomeningeal spinal metastases presented in only one case.
Conclusions: With a mean survival of only 4.5 months after identification of ILD, spinal metastases of GBM are a hallmark of extensive disease. Patients with ILD in GBM tend to be comparatively young, whereas their overall survival time is below the expected time span for that age group.
Highly astrocytically differentiated tumor cells (high GFAP expression) have a higher tendency for infiltrative growth, whereas low astrocytic differentiation (low GFAP expression) results in passive dissemination via cerebrospinal fluid pathways and induction of leptomeningeal spread. Hence leptomeningeal spread can be expected early in tumors with low astrocytic differentiation. We therefore recommend a regular whole spine imaging work‑up at the time of cranial MRI for all patients with cerebral GBM and low or non‑existent GFAP expression even though the patients might not be symptomatic at that time.
