1
|
Shah A, Marianayagam NJ, Zamarud A, Park DJ, Persad AR, Soltys SG, Chang SD, Veeravagu A. Spinal metastases of pineal region glioblastoma with primitive neuroectodermal features highlighting the importance of molecular diagnoses: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23536. [PMID: 37956418 PMCID: PMC10651388 DOI: 10.3171/case23536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common primary brain tumor with poor patient prognosis. Spinal leptomeningeal metastasis has been rarely reported, with long intervals between the initial discovery of the primary tumor in the brain and eventual spine metastasis. OBSERVATIONS Here, the authors present the case of a 51-year-old male presenting with 7 days of severe headache, nausea, and vomiting. Magnetic resonance imaging of the brain and spine demonstrated a contrast-enhancing mass in the pineal region, along with spinal metastases to T8, T12, and L5. Initial frozen-section diagnosis led to the treatment strategy for medulloblastoma, but further molecular analysis revealed characteristics of isocitrate dehydrogenase-wild type, grade 4 GBM. LESSONS Glioblastoma has the potential to show metastatic spread at the time of diagnosis. Spinal imaging should be considered in patients with clinical suspicion of leptomeningeal spread. Furthermore, molecular analysis should be confirmed following pathological diagnosis to fine-tune treatment strategies.
Collapse
Affiliation(s)
- Aaryan Shah
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, California
| | - Neelan J Marianayagam
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Aroosa Zamarud
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - David J Park
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Amit R Persad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Steven D Chang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| | - Anand Veeravagu
- Neurosurgery Artificial Intelligence Lab, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and
| |
Collapse
|
2
|
Lapolla P, Bruzzaniti P, Costarelli L, Frati A, Chen R, Li X, Miglietta S, Familiari G, Familiari P. Intramedullary Spinal Cord Metastasis Mimicking Astrocytoma: A Rare Case Report. Brain Sci 2021; 11:1124. [PMID: 34573146 DOI: 10.3390/brainsci11091124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 11/25/2022] Open
Abstract
Intramedullary spinal cord metastases (ISCMs) are infrequent lesions. Their incidence is estimated to range from 0.9 to 2.1%, found in autopsies of cancer patients. However, as the life expectancy of malignant tumour patients constantly increases, the reported incidences of ISCMs are consequently rising. This report presents a case of the misdiagnosis of an anaplastic astrocytoma type of tumour due to its similarities to small-cell neuroendocrine carcinoma. Therefore, we would like to underline the importance of further investigation that could assist and support the surgeon in the making of the differential diagnosis. We present the clinical case of a 73-year-old woman with a solitary intramedullary spinal cord metastasis as the initial manifestation of a carcinoid type of tumour. The patient was admitted to our department while presenting a rapid onset of paraparesis. Magnetic resonance imaging was performed, which showed an intramedullary mass at the C2–C6 vertebral level with a heterogeneous contrast enhancement. In light of these findings, the patient underwent surgery for a partial tumour resection. The lesion resulted in being a small-cell neuroendocrine type of carcinoma. This peculiar type of tumour presents similar radiological characteristics to the anaplastic astrocytoma type, which is why our diagnostical mismatch occurred. This is the report of a rare case of solitary intramedullary spinal cord metastasis, which is the result of an initial presentation of a lung small-cell neuroendocrine type of carcinoma. We conclude that ISCMs should be regularly considered as a part of the differential diagnosis of intramedullary lesions, especially in the case of a rapid onset and deterioration of neurological symptoms.
Collapse
|
3
|
Marchesini N, Feletti A, Bernasconi R, Ghimenton C, Sala F. Intramedullary spinal cord metastasis from an adenoid cystic carcinoma of the external auditory canal: case report. Br J Neurosurg 2021; 37:1-5. [PMID: 33970733 DOI: 10.1080/02688697.2021.1923653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND IMPORTANCE Intramedullary spinal cord metastases (ISCMs) are rare and no cases of ISCM from an adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) have been reported. CLINICAL PRESENTATION We report a 54-year old man complaining backpain and worsening myelopathy. He had an ACC of the EAC resected years prior. A spinal MRI demonstrated a contrast-enhancing intramedullary lesion within the conus medullaris. The histopathological diagnosis of the patient was consistent with the patient's primary cancer. At 3 months follow-up, the neurological condition of the patient was unchanged. CONCLUSIONS This is the first reported case of ISCM from a primary ACC of the EAC.
Collapse
Affiliation(s)
- N Marchesini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, Borgo Trento University Hospital, University of Verona, Verona, Italy
| | - A Feletti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, Borgo Trento University Hospital, University of Verona, Verona, Italy
| | - R Bernasconi
- Department of Pathology, Borgo University Trento Hospital, AOUI Verona, Verona, Italy
| | - C Ghimenton
- Department of Pathology, Borgo University Trento Hospital, AOUI Verona, Verona, Italy
| | - F Sala
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurosurgery, Borgo Trento University Hospital, University of Verona, Verona, Italy
| |
Collapse
|
4
|
Mariniello G, Peca C, Del Basso De Caro M, Carotenuto B, Formicola F, Elefante A, Maiuri F. Brain gliomas presenting with symptoms of spinal cord metastasis. Neuroradiol J 2015. [PMID: 26216664 DOI: 10.1177/1971400915594534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Three patients with brain gliomas (aged 41, 37, and 43 years) presented spinal cord symptoms as first neurological presentation (two cases) or at anaplastic progression (one case). Histologically, two cases were anaplastic (WHO III) astrocytomas and one anaplastic (WHO III) oligodendroglioma. The spinal surgery consisted of partial tumor resection in two cases with localized spinal cord metastasis, and tumor biopsy in another with diffuse spreading to the conus and cauda. Spinal irradiation was performed in one case. The time interval between the spinal surgery and the appearance of brain symptoms was very short (1 month or less). Two patients underwent brain surgery (tumor resection in one and stereotactic biopsy in another). The survival time was very short (2 and 3 months) in the two patients with anaplastic astrocytoma, whereas the patient with anaplastic oligodendroglioma survived 1 year after the spinal surgery. Brain gliomas may exceptionally present with symptoms of a spinal cord metastasis. The magnetic resonance imaging finding of a spinal cord enhancing lesion, particularly if associated with root enhancement, should suggest the presence of a brain glioma. In cases with a localized spinal lesion, an early spinal surgery is advised for both diagnosis and decompression of the nervous structures. However, the clinical outcome is poor and the survival time is short.
Collapse
Affiliation(s)
- Giuseppe Mariniello
- Department of Neurosciences and Reproductive and OdontostomatologicalSciences, Neurosurgical Clinic
| | - Carmela Peca
- Department of Neurosciences and Reproductive and OdontostomatologicalSciences, Neurosurgical Clinic
| | | | - Biagio Carotenuto
- Department of Advanced Biomedical Sciences, Section of Neuroradiology, "Federico II" University School of Medicine, Naples, Italy
| | - Fabiana Formicola
- Department of Advanced Biomedical Sciences, Section of Neuroradiology, "Federico II" University School of Medicine, Naples, Italy
| | - Andrea Elefante
- Department of Advanced Biomedical Sciences, Section of Neuroradiology, "Federico II" University School of Medicine, Naples, Italy
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and OdontostomatologicalSciences, Neurosurgical Clinic
| |
Collapse
|
5
|
Thudi NK, Shu ST, Martin CK, Lanigan LG, Nadella MV, Van Bokhoven A, Werbeck JL, Simmons JK, Murahari S, Kisseberth WC, Breen M, Williams C, Chen CS, McCauley LK, Keller ET, Rosol TJ. Development of a brain metastatic canine prostate cancer cell line. Prostate 2011; 71:1251-63. [PMID: 21321976 PMCID: PMC3139788 DOI: 10.1002/pros.21341] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 12/16/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Prostate cancer in men has a high mortality and morbidity due to metastatic disease. The pathobiology of prostate cancer metastasis is not well understood and cell lines and animal models that recapitulate the complex nature of the disease are needed. Therefore, the goal of the study was to establish and characterize a new prostate cancer line derived from a dog with spontaneous prostate cancer. METHODS A new cell line (Leo) was derived from a dog with spontaneous prostate cancer. Immunohistochemistry and PCR were used to characterize the primary prostate cancer and xenografts in nude mice. Subcutaneous tumor growth and metastases in nude mice were evaluated by bioluminescent imaging, radiography and histopathology. In vitro chemosensitivity of Leo cells to therapeutic agents was measured. RESULTS Leo cells expressed the secretory epithelial cytokeratins (CK)8, 18, and ductal cell marker, CK7. The cell line grew in vitro (over 75 passages) and was tumorigenic in the subcutis of nude mice. Following intracardiac injection, Leo cells metastasized to the brain, spinal cord, bone, and adrenal gland. The incidence of metastases was greatest to the central nervous system (80%) with a lower incidence to bone (20%) and the adrenal glands (16%). In vitro chemosensitivity assays demonstrated that Leo cells were sensitive to Velcade and an HDAC-42 inhibitor with IC(50) concentrations of 1.9 nm and 0.95 µm, respectively. CONCLUSION The new prostate cancer cell line (Leo) will be a valuable model to investigate the mechanisms of the brain and bone metastases.
Collapse
Affiliation(s)
- Nanda K. Thudi
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama, 35233
| | - Sherry T. Shu
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, 43210
| | - Chelsea K. Martin
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, 43210
| | - Lisa G. Lanigan
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, 43210
| | - Murali V.P. Nadella
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, 43210
| | - Adrie Van Bokhoven
- Department of Pathology, University of Colorado Health Sciences Center, Aurora, Colorado
| | - Jillian L. Werbeck
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, 43210
| | - Jessica K. Simmons
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, 43210
| | - Sridhar Murahari
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, 43210
| | - William C. Kisseberth
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, Ohio, 43210
| | - Matthew Breen
- Dept. of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh NC 27606
| | - Christina Williams
- Dept. of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh NC 27606
| | - Ching-Shih Chen
- Division of Medicinal Chemistry and Pharmacognosy, College of Pharmacy, The Ohio State University, Columbus, Ohio, 43210
| | - Laurie K. McCauley
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, MI 48109
| | - Evan T. Keller
- Departments of Urology and Pathology, School of Medicine, University of Michigan, Ann Arbor, MI 48109
| | - Thomas J. Rosol
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, 43210
| |
Collapse
|