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Table of Contents    
LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 333-335

Primary spinal cord glioblastoma multiforme: A report of two cases


1 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India

Date of Submission17-Jan-2012
Date of Decision11-Mar-2012
Date of Acceptance31-May-2012
Date of Web Publication14-Jul-2012

Correspondence Address:
Ashok K Mahapatra
Department of Neuropathology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.98530

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How to cite this article:
Prasad G L, Borkar SA, Subbarao KC, Suri V, Mahapatra AK. Primary spinal cord glioblastoma multiforme: A report of two cases. Neurol India 2012;60:333-5

How to cite this URL:
Prasad G L, Borkar SA, Subbarao KC, Suri V, Mahapatra AK. Primary spinal cord glioblastoma multiforme: A report of two cases. Neurol India [serial online] 2012 [cited 2021 Sep 17];60:333-5. Available from: https://www.neurologyindia.com/text.asp?2012/60/3/333/98530


Sir,

Primary spinal cord glioblastoma multiforme (GBM) is an extremely rare tumor constituting about 3% of intramedullary spinal cord neoplasms, hence this report. Case profile of both the patients has been summarized in [Table 1].
Table 1: Clinico-radio-pathological profile of both the cases

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Both ependymoma and astrocytoma in combination make up for around 70% of intramedullary neoplasms. [1] Barring a very few small series, majority of the published primary spinal cord GBMs are isolated case reports. [2],[3] Although GBM is the most common primary brain neoplasm in adults and makes up almost 50% of all astrocytic tumors, they are exceptionally rare in the spinal cord, amounting to only 3% of all intramedullary tumors. [1] The relatively low proportion of absolute number of neuroglial cells (as compared to brain) in the spinal cord probably accounts for the rarity of these neoplasms in the spinal cord. [4] With some very exceptional cases such as radiation-induced ones, [3],[5] spinal cord GBM either arises de novo as a primary neoplasm or disseminates from an intracranial focus. Raco et al., in their series of 202 intramedullary tumors, reported the incidence of grade 3 and 4 astrocytomas in 20%. [4] In contrast to cranial GBM, spinal GBM is typically found in the younger age groups. None of the cases were more than 45 years old in the study of Asano et al. [6] Similarly, Ciapetti et al. noted that only 3 out of 7 cases were older than 45 years. [7] In our study, both the patients were below 45 years. The most common location is the thoracic region, and conus location is relatively rare. Majority of the cases reported the tumor spanning more than four spinal levels. As in the case of high-grade tumors, both of our patients presented with rapidly progressive neurological deficits of short duration. There are no imaging features specific for these neoplasms and most of them show a heterogeneously enhancing lesion with enlargement of the spinal cord. [1] [Figure 1], [Figure 2] and [Figure 3]
Figure 1: MRI cervico-dorsal spine (sagittal and axial) showing a heterogeneously enhancing intramedullary lesion from C6 to D7 with enlargement of cord

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Figure 2: MRI dorso-lumbar spine (sagittal T2W and T1 contrast) showing a heterogeneously enhancing intramedullary lesion from D11 to L1 with enlargement of cord

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Figure 3: Photomicrographs showing a highly cellular astrocytic tumor with frequent mitosis, necrosis, and hyperchromatic pleomorphic tumor cells (H and E, ×400) (a). Immunohistochemical staining shows positivity for P53 (×200) (b) and positivity for GFAP (×200) (c)

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Although the optimal management remains yet unclear, in view of highly infiltrative nature, tumor decompression is all that is needed for these high-grade tumors. All cases should have a frozen section done, which along with the presence of surgical plane of dissection guide resection. Safe surgical resection should be the goal of surgery. Even with this conservative approach, many patients develop worsening of neurological status. In the series of Raco et al., 61% had worsening of symptoms after surgery for grade 3 and 4 astrocytomas. [4] There appears to be a relatively high leptomeningeal involvement and CSF dissemination is an important cause of mortality. [4],[8],[9] Whole brain irradiation in addition to focal spinal irradiation should be given to patients with spinal cord GBM because of the possibility of intrathecal dissemination. [6],[8] Median overall survival time of spinal GBM is around 6-18 months. [10],[11] A rare case of prolonged survival has been reported by Marchan et al. where cordectomy was performed in a paraplegic patient to delay the intracranial dissemination. [12] Many reports have documented improved survival following the addition of chemotherapy. Drugs that have been used include temozolamide and other trial agents such as anti-angiogenesis agents and immunotoxins. [13] Several adjuncts have been tried to prolong the survival period including intrathecal beta-interferon, intrathecal immunotherapy using lymphokine-activated killer T cells, but without consistent results. [6],[14] In spite of these measures, the final outcome of spinal GBM remains dismal similar to that of the intracranial ones. To conclude, spinal cord GBM are rare tumors with no specific imaging features. Goal of surgery should be safe surgical resection. Adjuvant management includes radiotherapy, both focal and prophylactic cranial irradiation. Role of addition of chemotherapy is controversial. Recurrences are the rule and overall prognosis is dismal despite multimodality treatment.

 
 » References Top

1.Koeller KK, Rosenblum RS, Morrison AL. Neoplasms of the spinal cord and filum terminale: Radiologic-pathologic correlation. Radiographics 2000;20:1721-49.  Back to cited text no. 1
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2.Constantini S, Houten J, Miller DC, Freed D, Ozek MM, Rorke LB, et al. Intramedullary spinal cord tumors in children under the age of 3 years. J Neurosurg 1996;85:1036-43.  Back to cited text no. 2
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3.Yeung YF, Wong GK, Zhu XL, Ma BB, Hk NG, Poon WS. Radiation induced spinal glioblastoma multiforme. Acta Oncologica 2006;45:87- 90.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Raco A, Espito V, Lenzi J, Piccirilli M, Delfini R, Cantore G, et al. Long-term follow-up of intramedullary spinal cord tumors: A series of 202 cases. Neurosurgery 2005;56:972-9.  Back to cited text no. 4
    
5.Ching NG, Fairhall J, Rathmalgoda C, Stening W, Smee R. Spinal cord glioblastoma multiforme induced by radiation after treatment for Hodgkin disease. J Neurosurg Spine 2007;6:364-7.  Back to cited text no. 5
    
6.Asano N, Kitamura K, Seo Y, Mukai K, Soga T, Hondo H, et al. Spinal cord glioblastoma multiforme with intracranial dissemination-case report. Neurol Med Chir (Tokyo) 1990;30:489-94.  Back to cited text no. 6
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7.Ciappetta P, Salvati M, Capoccia G. Spinal glioblastomas: Report of seven cases and review of the literature. Neurosurgery 1991;28:302-6.  Back to cited text no. 7
    
8.Lober R, Sharma S, Bell B, Free A, Figueroa R, Shiels CW, et al. Pediatric primary intramedullary spinal cord glioblastoma. Rare Tumors 2010;2:135-41.  Back to cited text no. 8
    
9.Strik HM, Effenberger O, Schäfer O, Risch U, Wickboldt J, Meyermann R. A case of spinal glioblastoma multiforme: Immunohistochemical study and review of the literature. J Neurooncol 2000;50:239-43.  Back to cited text no. 9
    
10.Takara E, Ide M, Yamamoto M, Imanaga H, Jimbo M, Imai M. A case of the intracranial and spinal dissemination of primary spinal glioma. No Shinkei Geka 1985;13:301-5.  Back to cited text no. 10
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11.Singh PK, Singh VK, Tomar J, Azam A, Gupta S, Kumar S. Spinal glioblastoma multiforme: Unusual cause of post-traumatic tetraparesis. J Spinal Cord Med 2009;32:583-6.  Back to cited text no. 11
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12.Marchan EM, Sekula RF Jr, Jannetta PJ, Quigley MR. Long term survival enhanced by cordectomy in a patient with a spinal glioblastoma multiforme and paraplegia. Case report. J Neurosurg Spine 2007;7:656- 9.  Back to cited text no. 12
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13.Allen JC, Aviner S, Yates AJ, Boyett JM, Cherlow JM, Turski PA, et al. Treatment of high-grade spinal cord astrocytoma of childhood with "8-in-1" chemotherapy and radiotherapy: A pilot study of CCG-945. Children's Cancer Group. J Neurosurg 1998;88:215-20.  Back to cited text no. 13
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14.Yamazaki M, Ikota T, Ohkata N, Tashiro T, Sawamura Y, Iwasaki Y, et al. A case of spinal cord glioblastoma multiforme. No Shinkei Geka 1992;20:85-9.  Back to cited text no. 14
    


    Figures

  [Table 1], [Figure 1], [Figure 2], [Figure 3]

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