Pulmonary Metastasis from Glioblastoma Multiforme-A Rare Case Report

罕見病例報告：膠質母細胞瘤合併肺轉移

何建輝(Chien-Hui He) ； 陳育民(Yuh-Min Chen) ； 施振甫(Jen-Fu Shih) ； 葉奕成(Yi-Chen Yeh) ； 蕭逸函(Yi-Han Hsiao)

《胸腔醫學》 34卷6期 (2019/12) Pp. 270-277

摘要

Glioblastoma multiforme (GBM) is the most common, aggressive brain tumor, and has a poor prognosis. Extracranial GBM metastases are rare because of the protection of the bloodbrain barrier and the lack of a lymphatic drainage system in the central nervous system (CNS). We reported a 51-year-old female who was diagnosed as having GBM, and who underwent a craniotomy for tumor removal. CNS recurrence was noted 14 months later with the incidental finding of a soft-tissue mass in the right lower lobe of the lung. The cytopathological examination from the lung mass biopsy revealed large, pleomorphic, spindle- to bizarreshaped cells with dense cytoplasm, immunoreactive for glial fibrillary acidic protein and nonreactive for cytokeratin, which could very well be compatible with a metastatic glioblastoma. Although less than 2% of GBM patients have been reported to have extra-CNS metastases, including to the lungs, pleura, lymph nodes, bones, and liver, this occurrence indicates there are other potential pathways such as vascular invasion that allow GBM to escape the CNS. With the progress there has been in optimal therapy and the probability of longer survival, physicians should be aware of this rare clinical entity, especially when approaching extra- CNS lesions in GBM patients.

關鍵字

glioblastoma multiforme (GBM) ； pulmonary metastasis

並列摘要

膠質母細胞瘤（GBM）是最常見和侵襲性且預後不良的腦腫瘤。由於中樞神經系統（CNS）中血腦屏障的保護和淋巴引流系統的分布，顱外膠質母細胞瘤轉移是罕見的。我們報導了一名51歲的女性被診斷為膠質母細胞瘤，接受了開顱手術切除腫瘤，14個月後發現腦部復發，偶然發現肺右下葉有軟組織腫塊。來自肺部組織檢查的細胞病理學檢查顯示：許多大且多形性梭形（spindle），怪異形狀（bizarre-shaped）的細胞，並具有緻密的細胞質，對GFAP具有免疫反應性，但對CK具沒有反應性，這符合轉移性膠質母細胞瘤的診斷。據報導，只有不到2%的膠質母細胞瘤患者有中樞神經外轉移，其中包括肺，胸膜，淋巴結，骨骼和肝臟。其中表示其他可能的轉移途徑如血管侵犯，使膠質母細胞瘤離開中樞神經系統。隨著治療的進展和病人有更長的生存概率，醫生應該意識到這種罕見的膠質母細胞瘤合併中樞神經外轉移的病例。

並列關鍵字

膠質母細胞瘤 ； 肺轉移