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Yuen CA, Pekmezci M, Bao S, Kong XT. Metastatic glioblastoma to the lungs: a case report and literature review. CNS Oncol 2024; 13:2351789. [PMID: 38864820 PMCID: PMC11172249 DOI: 10.1080/20450907.2024.2351789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/02/2024] [Indexed: 06/13/2024] Open
Abstract
Glioblastoma is the most common malignant primary brain tumor. Despite its infiltrative nature, extra-cranial glioblastoma metastases are rare. We present a case of a 63-year-old woman with metastatic glioblastoma in the lungs. Sarcomatous histology, a reported risk factor for disseminated disease, was found. Genomic alterations of TP53 mutation, TERT mutation, PTEN mutation, and +7/-10 were also uncovered. Early evidence suggests these molecular aberrations are common in metastatic glioblastoma. Treatment with third-line lenvatinib resulted in a mixed response. This case contributes to the growing body of evidence for the role of genomic alterations in predictive risk in metastatic glioblastoma. There remains an unmet need for treatment of metastatic glioblastoma.
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Affiliation(s)
- Carlen A Yuen
- Department of Neurology, Division of Neuro-Oncology, University of California, Irvine, CA92868, USA
| | - Melike Pekmezci
- Department of Pathology, University of California, San Francisco, CA94143, USA
| | - Silin Bao
- Department of Internal Medicine, Division of Neurosciences, Community Regional Medical Center, Fresno, CA93721, USA
| | - Xiao-Tang Kong
- Department of Neurology, Division of Neuro-Oncology, University of California, Irvine, CA92868, USA
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2
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Paliwal A, Faust K, Alshoumer A, Diamandis P. Standardizing analysis of intra-tumoral heterogeneity with computational pathology. Genes Chromosomes Cancer 2023; 62:526-539. [PMID: 37067005 DOI: 10.1002/gcc.23146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023] Open
Abstract
Many malignant cancers like glioblastoma are highly adaptive diseases that dynamically change their regional biology to survive and thrive under diverse microenvironmental and therapeutic pressures. While the concept of intra-tumoral heterogeneity has become a major paradigm in cancer research and care, systematic approaches to assess and document bio-variation in cancer are still in their infancy. Here we discuss existing approaches and challenges to documenting intra-tumoral heterogeneity and emerging computational approaches that leverage artificial intelligence to begin to overcome these limitations. We propose how these emerging techniques can be coupled with a diversity of molecular tools to address intra-tumoral heterogeneity more systematically in research and in practice, especially across larger specimens and longitudinal analyses. Systematic documentation and characterization of heterogeneity across entire tumor specimens and their longitudinal evolution has the potential to improve our understanding and treatment of cancer.
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Affiliation(s)
- Ameesha Paliwal
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Faust
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Azhar Alshoumer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Phedias Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Laboratory Medicine Program, Department of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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3
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Rong T, Zou W, Qiu X, Cui W, Zhang D, Wu B, Kang Z, Li W, Liu B. A Rare Manifestation of a Presumed Non-Osteophilic Brain Neoplasm: Extensive Axial Skeletal Metastases From Glioblastoma With Primitive Neuronal Components. Front Oncol 2021; 11:760697. [PMID: 34796114 PMCID: PMC8593252 DOI: 10.3389/fonc.2021.760697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Glioblastoma multiforme (GBM) is the most common malignant tumor of the central nervous system. GBM with primitive neuronal component (GBM-PNC) is an aggressive variant identified in 0.5% of GBMs. Extracranial metastasis from GBM-PNC is a rare and challenging situation. Methods A special case of early-onset GBM with systemic bone metastasis was enrolled. Clinical data, including patient characteristics, disease course, and serial radiological images were retrieved and analyzed. Tumor tissues were obtained by surgical resections and were made into formalin-fixed paraffin-embedded sections. Histopathological examinations and genetic testing were performed for both the primary and metastatic tumor specimens. Results A 20-year-old man suffered from GBM with acute intratumoral hemorrhage of the left temporal lobe. He was treated by gross total resection and chemoradiotherapy following the Stupp protocol. Seven months later, he returned with a five-week history of progressive neck pain and unsteady gait. The radiographic examinations identified vertebral collapse at C4 and C6. Similar osteolytic lesions were also observed at the thoracolumbar spine, pelvic, and left femur. Anterior spondylectomy of C4 and C6 was performed. The resected vertebral bodies were infiltrated with greyish, soft, and ill-defined tumor tissue. One month later, he developed mechanical low-back pain and paraplegia caused by thoracolumbar metastases. Another spine surgery was performed, including T10 total en-bloc spondylectomy, T7-9, L2-3, and L5-S1 laminectomy. After the operation, the patient’s neurological function and spinal stability remained stable. However, he finally succumbed to the rapidly increased tumor burden and died 15 months from onset because of cachexia and multiple organ failure. In addition to typical GBM morphology, the histological examinations identified monomorphic small-round cells with positive immunohistochemical staining of synaptophysin and CD99, indicating the coexistence of PNC. The next-generation sequencing detected pathogenic mutations in TP53 and DNMT3A. Based on above findings, a confirmed diagnosis of systemic metastases from GBM-PNC (IDH-wild type, WHO grade IV) was made. Conclusions The present case highlights the occurrence and severity of extensive axial skeletal metastases from GBM-PNC. This rare variant of GBM requires aggressive multimodal treatment including surgery and chemoradiotherapy targeting PNC. The pathological screening of PNC is recommended in patients with early-onset GBM and intratumoral hemorrhage. Surgery for spinal metastasis is appropriate in patients with chemoradioresistance and relatively good general status, with the objectives of restoring spinal stability and relieving spinal cord compression.
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Affiliation(s)
- Tianhua Rong
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Basic and Translational Medicine Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanjing Zou
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Duo Zhang
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Bingxuan Wu
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Basic and Translational Medicine Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhuang Kang
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenbin Li
- Department of Neuro-Oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baoge Liu
- Department of Orthopaedic Surgery, Spine Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.,Basic and Translational Medicine Center, China National Clinical Research Center for Neurological Diseases, Beijing, China
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4
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Schwock J, Mirham L, Ghorab Z. Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update. Acta Cytol 2021; 65:529-540. [PMID: 34311461 PMCID: PMC8686714 DOI: 10.1159/000517480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/27/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Extraneural/-cranial metastases (ENM) of primary central nervous system (CNS) tumors are rare and may be diagnostically challenging. We describe the cytomorphological and pertinent clinical features of ENM in a case series assessed by fine-needle aspiration (FNA). A search of the laboratory information systems of 2 tertiary care centers in Toronto (2000-2015) was performed. Cases with direct extracranial/-spinal extension of CNS neoplasms were excluded. Microscopic slides of FNA and surgical specimens were reviewed. Demographic and clinicopathological data were retrieved. CASE PRESENTATION Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22-56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area. DISCUSSION/CONCLUSION ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.
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Affiliation(s)
- Joerg Schwock
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lorna Mirham
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Maekawa K, Tokumitsu T, Noguchi H, Nakamura E, Gi T, Horinouchi S, Yamashita S, Takeshima H, Asada Y, Sato Y. Glioblastoma mimicking metastatic small cell carcinoma: A case report with ultrastructural findings. Diagn Cytopathol 2021; 49:E291-E296. [PMID: 33609337 DOI: 10.1002/dc.24715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 11/08/2022]
Abstract
It is often straightforward to distinguish glioblastoma (GBM) from metastatic carcinoma by cytology; however, small cell variants of GBM or GBM with primitive neuronal component (GBMPNC) can mimic metastatic small cell carcinoma (SCC). Herein, we report a case of GBMPNC mimicking metastatic SCC and present cytological and ultrastructural findings. A 65-year-old man with memory disturbance was hospitalized. Magnetic resonance imaging revealed the presence of a 6 cm sized tumor in the right anterior temporal lobe. Intraoperative cytology slides indicated that the tumor consisted of small-sized cells with scant cytoplasm showing high cellularity. The initial intraoperative diagnosis was metastatic SCC; however, any primary visceral tumor was not detected clinically. Immunohistochemical and ultrastructural studies of postoperative histological sections revealed that the lesion was GBMPNC. This case shows that some GBMs may have the potential to closely mimic metastatic SCC, which expands the differential diagnosis and emphasizes the importance of clinical correlation.
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Affiliation(s)
- Kazunari Maekawa
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takako Tokumitsu
- Division of Pathology, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Noguchi
- Division of Pathology, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Eriko Nakamura
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Toshihiro Gi
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shoichi Horinouchi
- Department of Neurosurgery, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shinji Yamashita
- Department of Neurosurgery, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hideo Takeshima
- Department of Neurosurgery, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yujiro Asada
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.,Division of Pathology, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuichiro Sato
- Division of Pathology, Miyazaki University Hospital, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Shayganfar A, Ebrahimian S, Mahzouni P, Shirani F, Aalinezhad M. A review of glioblastoma tumors with primitive neuronal component and a case report of a patient with this uncommon tumor at a rare location. Clin Case Rep 2020; 8:2600-2604. [PMID: 33363787 PMCID: PMC7752627 DOI: 10.1002/ccr3.3228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/10/2020] [Accepted: 07/17/2020] [Indexed: 11/15/2022] Open
Abstract
Glioblastoma with primitive neuronal component should be considered as a differential diagnosis of infratentorial tumors.
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Affiliation(s)
- Azin Shayganfar
- Department of RadiologyIsfahan University of Medical SciencesIsfahanIran
| | - Shadi Ebrahimian
- Department of RadiologyIsfahan University of Medical SciencesIsfahanIran
| | - Parvin Mahzouni
- Department of PathologyIsfahan University of Medical SciencesIsfahanIran
| | - Fattane Shirani
- Department of RadiologyIsfahan University of Medical SciencesIsfahanIran
| | - Marzieh Aalinezhad
- Department of RadiologyIsfahan University of Medical SciencesIsfahanIran
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