Glioblastoma Multiforme with Subcutaneous Metastases, Case Report and Literature Review
A 19-year-old female patient presented with debility of left limbs for 2 days (d). Neurological examination revealed muscle strength of left limbs was graded IV. Cranial magnetic resonance (MR) showed a cystic mass measuring 2.0×2.5×3.0 cm located at the right part of pons; contrast MR () showed the tumor was ring-enhanced with necrosis. The operation was performed via retro-sigmoid approach, and pathological examinations of the lesion confirmed as GBM (World Health Organization grade IV) that had variable histological features, such as mitosis, endothelial proliferation and necrosis (). Immunohistochemical results showed that the tumor cells were positive for glial fibrillary acidic protein (GFAP) and S-100 protein (). After operation, the patient was treated with three-dimensional conformal radiotherapy for 6 weeks (60 Gy in total with 30 fractions of 2 Gy) and concomitant temozolomide chemotherapy (75 mg/m2/daily for 42 d). After that, adjuvant temozolomide chemotherapy (150 mg/m2/daily for 5 d with every 28 d for 1 chemotherapy course) was suggested; however, the patient's family refused that because of financial reasons. 8 months after operation, the patient noticed an enlarging subcutaneous swelling at the left posterior cervical region On examination, a very firm, immobile subcutaneous swelling measured 2.5×3.0 cm was palpated. Follow-up MR () scan showed that recurrence of pontine GBM, and an enhanced subcutaneous swelling at the left posterior cervical region was evident on magnetic resonance imaging. The swelling was resected, and pathological examinations, immunohistochemical results showed the same characteristics as the primary intracranial GBM cells (). Thus, a diagnosis of GBM metastasizing to the cervical subcutaneous tissue was rendered. As a result, temozolomide chemotherapy (150 mg/m2/daily for 5 d) and radiotherapy was administrated to the patient. 6-month-long follow up showed that there was no recurrence of the cervical subcutaneous tumor.