An Autopsied Case of Glioblastoma associated with Massive Leptomeningeal Gliomatosis without Definite Growing of the Primary Lesion

Abstract

The authors report a race case of glioblastoma in which the patient's condition rapidly deteriorated due to a massive leptomeningeal gliomatosis without definite growth of the primary lesion. A 48-year-old man was hospitalized with complaints of occipital and nuchal pains. CT and MRI on admission showed a small tumor in the lateral wall of the right trigone partially projecting into the ventricle without any finding of leptomeningeal gliomatosis. Subsequently, his consciousness level worsened gradually with rapidly developed leptomeningeal gliomatosis which was demonstrated on enhanced MRI. He received intrathecal chemotherapy through an Ommaya catheter and by lumbar puncture, without any effects on gliomatosis. He died 7 weeks after admission. At autopsy, an intraparenchymal tumor, 5×10×15mm in diameter, was found in the deep white matter of the right parietal lobe facing and extending into the right lateral ventricle. The ependymal layer in the region of the tumor had been destroyed. Infiltration of tumor cells was seen diffusely in the leptomeninges of the surface of the brain and spinal cord, but not in the ventricular walls. Histopathological patterns of the intraparenchymal and leptomeningeal tumors were similar and compatible with the typical features of glioblastoma. However, immunohistological study demonstrated different findings for both lesion ; the leptomeningeal tumor was more poorly differentiated (GFAP(-), PCNA 94%) than the intraparenchymal tumor (GFAP(+), PCNA 42%). It is suggested that the biological characteristics may play a part in the development leptomeningeal gliomatosis in addition to the anatomical characteristics.