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Table of Contents    
NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 2  |  Page : 836

Cervical Lymph Node Metastasis in Glioblastoma Multiformae


1 Department of Neurosurgery, Columbia Asia Hospital, Patiala, Punjab, India
2 Department of Pathology, Columbia Asia Hospital, Patiala, Punjab, India

Date of Submission05-Jul-2021
Date of Decision28-Jul-2021
Date of Acceptance08-Sep-2021
Date of Web Publication3-May-2022

Correspondence Address:
Dr. Jaskaran Singh
Department of Neurosurgery, Columbia Asia Hospital, Patiala, Punjab - 147 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.344663

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How to cite this article:
Singh J, Kaur J. Cervical Lymph Node Metastasis in Glioblastoma Multiformae. Neurol India 2022;70:836

How to cite this URL:
Singh J, Kaur J. Cervical Lymph Node Metastasis in Glioblastoma Multiformae. Neurol India [serial online] 2022 [cited 2022 Jun 26];70:836. Available from: https://www.neurologyindia.com/text.asp?2022/70/2/836/344663




Metastasis in cases of glioblastoma multiforme are extremely rare, having an incidence of 0.2%−2% in the literature.[1],[2] These are generally seen post-surgery or when there is a breach of the blood − brain barrier due to local extradural spread. The possible mechanism of metastasis suggested are lymphatic spread, venous invasion, and direct invasion through dura and bone.[1],[2],[3],[4] Most common sites of metastasis are lungs/pleura, lymph nodes, bones, and liver.[1],[2] Here we present a case of a 45-year-old female patient who was operated for recurrent left temporal glioma (first biopsy was low-grade glioma WHO grade 2, operated 1.5 years back). The histopathology was consistent with GBM (WHO grade 4). Immunohistochemistry revealed GFAP positive, IDH-1 mutant with 40% Ki-67 index. After the second surgery, she received chemo-radiotherapy but developed a neck swelling six months after the second surgery (while on tocilizumab). MRI [Figure 1] showed a T1 hypointense, T2 hyperintense neck tumor with heterogeneous contrast enhancement.
Figure 1: (a) Sagittal section of contrast MRI with blue arrow pointing to the primary resection site having peripheral enhancement (? Recurrent lesion), red arrow showing a separate mass in the posterior triangle of neck having heterogeneous contrast enhancement. (b) FNAC of neck mass which revealed highly pleomorphic malignant cells with high nuclear: Cytoplasmic ratio in a background of fibrillary processes and lymphocytes (40× magnification, H&E stain) consistent with lymph node metastasis of glioblastoma multiforme

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Declaration of patient consent

Full and detailed consent from the patient/guardian has been taken. The patient's identity has been adequately anonymized. If anything related to the patient's identity is shown, adequate consent has been taken from the patient/relative/guardian. The journal will not be responsible for any medico-legal issues arising out of issues related to the patient's identity or any other issues arising from the public display of the video.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Seo YJ, Cho WH, Kang DW, Cha SH. Extraneural metastasis of glioblastoma multiforme presenting as an unusual neck mass. J Korean Neurosurg Soc 2012;51:147-50.  Back to cited text no. 1
    
2.
Kalokhe G, Grimm SA, Chandler JP, Helenowski I, Rademaker A, Raizer JJ. Metastatic glioblastoma: Case presentations and a review of the literature. J Neurooncol 2012;107:21-7.  Back to cited text no. 2
    
3.
Zhen L, Yufeng C, Zhenyu S, Lei X. Multiple extracranial metastases from secondary glioblastoma multiforme: A case report and review of the literature. J Neurooncol 2010;97:451-7.  Back to cited text no. 3
    
4.
Amitendu S, Mak SK, Ling JM, Ng WH. A single institution experience of the incidence of extracranial metastasis in glioma. J Clin Neurosci 2012;19:1511-5.  Back to cited text no. 4
    


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