Carlen Yuen1, Melike Pekmezci3, Silin Bao4, Xiao-Tang Kong2
1Neuro-oncology, 2Neuro-Oncology, University of California, Irvine, 3Pathology, University of California, San Francisco, 4Community Regional Medical Center
Objective:
We present a case of a 63-year-old woman with metastatic glioblastoma in the lungs. We examine possible risk factors, including genomic alterations, for the development of her extra-neural disease. We also describe her treatment response to lenvatinib monotherapy.
Background:
Glioblastoma is the most commonly occurring malignant primary brain tumor [1]. Despite the infiltrative nature of glioblastoma, metastases are infrequent with an incidence of only 0.4–2.0%. Accordingly, the rare detection of metastases has resulted in the forgoing of staging for glioblastoma. However, cases are on the rise due to heightened awareness and evidence suggests that 20% of glioblastoma cases are found to have tumor-circulating cells. Despite this finding, glioblastoma predominantly remains an intracranial disease. For the subset of cases in which metastases do occur, extra-cranial intra-neural drop metastases to the spine are more common than extra-neural dissemination to outside organs. Prognosis remains especially poor with a median overall survival of 10.5 months.
Design/Methods:
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.
Results:
A dramatic response was observed in her intracranial tumor. Her systemic lung disease did not demonstrate a response to lenvatinib.
Conclusions:
Though rare, extra-neural metastases should be considered in the differential of a glioblastoma patient with new systemic symptoms. Early evidence gleaned from metastatic glioblastoma case studies suggests that genomic alterations may play a role in predicting risk for metastatic glioblastoma. Treatment options are needed for metastatic glioblastoma and novel therapies should be investigated.
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