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LETTER TO EDITOR
Year : 2012  |  Volume : 60  |  Issue : 3  |  Page : 333--335

Primary spinal cord glioblastoma multiforme: A report of two cases

G Lakshmi Prasad1, Sachin A Borkar2, Kiran C Subbarao2, Vaishali Suri2, Ashok K Mahapatra2,  
1 Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
2 Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Ashok K Mahapatra
Department of Neuropathology, All India Institute of Medical Sciences, New Delhi
India




How to cite this article:
Prasad G L, Borkar SA, Subbarao KC, Suri V, Mahapatra AK. Primary spinal cord glioblastoma multiforme: A report of two cases.Neurol India 2012;60:333-335


How to cite this URL:
Prasad G L, Borkar SA, Subbarao KC, Suri V, Mahapatra AK. Primary spinal cord glioblastoma multiforme: A report of two cases. Neurol India [serial online] 2012 [cited 2022 Jan 19 ];60:333-335
Available from: https://www.neurologyindia.com/text.asp?2012/60/3/333/98530


Full Text

Sir,

Primary spinal cord glioblastoma multiforme (GBM) is an extremely rare tumor constituting about 3% of intramedullary spinal cord neoplasms, hence this report. Case profile of both the patients has been summarized in [Table 1].{Table 1}

Both ependymoma and astrocytoma in combination make up for around 70% of intramedullary neoplasms. [1] Barring a very few small series, majority of the published primary spinal cord GBMs are isolated case reports. [2],[3] Although GBM is the most common primary brain neoplasm in adults and makes up almost 50% of all astrocytic tumors, they are exceptionally rare in the spinal cord, amounting to only 3% of all intramedullary tumors. [1] The relatively low proportion of absolute number of neuroglial cells (as compared to brain) in the spinal cord probably accounts for the rarity of these neoplasms in the spinal cord. [4] With some very exceptional cases such as radiation-induced ones, [3],[5] spinal cord GBM either arises de novo as a primary neoplasm or disseminates from an intracranial focus. Raco et al., in their series of 202 intramedullary tumors, reported the incidence of grade 3 and 4 astrocytomas in 20%. [4] In contrast to cranial GBM, spinal GBM is typically found in the younger age groups. None of the cases were more than 45 years old in the study of Asano et al. [6] Similarly, Ciapetti et al. noted that only 3 out of 7 cases were older than 45 years. [7] In our study, both the patients were below 45 years. The most common location is the thoracic region, and conus location is relatively rare. Majority of the cases reported the tumor spanning more than four spinal levels. As in the case of high-grade tumors, both of our patients presented with rapidly progressive neurological deficits of short duration. There are no imaging features specific for these neoplasms and most of them show a heterogeneously enhancing lesion with enlargement of the spinal cord. [1] [Figure 1], [Figure 2] and [Figure 3] {Figure 1}{Figure 2}{Figure 3}

Although the optimal management remains yet unclear, in view of highly infiltrative nature, tumor decompression is all that is needed for these high-grade tumors. All cases should have a frozen section done, which along with the presence of surgical plane of dissection guide resection. Safe surgical resection should be the goal of surgery. Even with this conservative approach, many patients develop worsening of neurological status. In the series of Raco et al., 61% had worsening of symptoms after surgery for grade 3 and 4 astrocytomas. [4] There appears to be a relatively high leptomeningeal involvement and CSF dissemination is an important cause of mortality. [4],[8],[9] Whole brain irradiation in addition to focal spinal irradiation should be given to patients with spinal cord GBM because of the possibility of intrathecal dissemination. [6],[8] Median overall survival time of spinal GBM is around 6-18 months. [10],[11] A rare case of prolonged survival has been reported by Marchan et al. where cordectomy was performed in a paraplegic patient to delay the intracranial dissemination. [12] Many reports have documented improved survival following the addition of chemotherapy. Drugs that have been used include temozolamide and other trial agents such as anti-angiogenesis agents and immunotoxins. [13] Several adjuncts have been tried to prolong the survival period including intrathecal beta-interferon, intrathecal immunotherapy using lymphokine-activated killer T cells, but without consistent results. [6],[14] In spite of these measures, the final outcome of spinal GBM remains dismal similar to that of the intracranial ones. To conclude, spinal cord GBM are rare tumors with no specific imaging features. Goal of surgery should be safe surgical resection. Adjuvant management includes radiotherapy, both focal and prophylactic cranial irradiation. Role of addition of chemotherapy is controversial. Recurrences are the rule and overall prognosis is dismal despite multimodality treatment.

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