RARE-21GLIOBLASTOMA WITH LEPTOMENINGEAL AND INTRAMEDULLARY METASTASES AT TIME OF INITIAL DIAGNOSIS IN AN ELDERLY PATIENT: A CASE REPORT

Unfortunately, glioblastoma multiforme (GBM) continues to be an incurable, highly aggressive central nervous system malignancy. Extracranial dissemination of GBM is exceedingly rare, with most case reports indicating dissemination either as a post-surgical result or at time of disease progression. Here we present a case of an 85 year old woman who initially presented with confusion, falls, and episodic aphasia. MRI of the brain demonstrated a 2.2cm enhancing mass in the left occipital lobe. Patient was subsequently found to have leptomeningeal and intramedullary metastases at the time of initial diagnosis. Biopsy of the occipital mass was consistent with MGMT methylated GBM. Given patient's age and performance status, along with recent data supporting the efficacy of temozolomide monotherapy in elderly patient with MGMT methylated glioblastoma, patient elected to withhold brain radiation, proceeding with temozolomide monotherapy with palliative radiation therapy to her spinal deposits. She unfortunately experienced a rapid decline, with an overall survival of 6 weeks. This case presents a patient where MGMT monotherapy did not stabilize her disseminated disease. Further, the lack of radiographic evidence of direct tumor extension into the cerebrospinal fluid suggests a more invasive tumor phenotype allowing for the early dissemination. Further tumor biology research is required in this subset of patients regarding the mechanism for extracranial disease dissemination.