Primary Extra-axial Glioblastoma: Case Report and Literature Review

Abstract

Glioblastoma multiforme (GBM) is the most frequent and most aggressive primary brain tumor in adults, mainly located in the cerebral hemispheres. In the literature, few cases of primary GBM have been reported to have radiographic and intraoperative features of extra-axial lesions, leading to a diagnostic dilemma. Despite the advances in imaging modalities, the diagnosis of GBM can be challenging, and it is mainly based on the histopathologic confirmation of the excised tumor. We describe the case of a 76-year-old previously healthy female patient who presented to our hospital due to speech disturbances and cognitive impairment. The diagnosis of the tumor type on magnetic resonance imaging (MRI) was difficult, as the findings were suggestive of a malignant meningioma due to the heterogeneous enhancement of a dural-based mass with a dural tail sign. Moreover, the intraoperative findings revealed an extra-axial mass attached to the dura. A histological examination confirmed the diagnosis of glioblastoma with arachnoid infiltration. The patient underwent adjuvant radiotherapy and concomitant temozolomide treatment, she had clinical improvement postoperatively, and was stable during the six months of follow-up. Glioblastoma should be considered in the differential diagnosis of primary extra-axial mass with atypical and malignant features, especially in elderly patients.

Abstrata

O glioblastoma multiforme (GBM) é o tumor cerebral primário mais frequente e agressivo em adultos, localizado principalmente nos hemisférios cerebrais. Na literatura, poucos casos de GBM primário foram relatados com características radiográficas e intraoperatórias de lesões extra-axiais, o que leva a um dilema diagnóstico. Apesar dos avanços nas modalidades de imagiologia, o diagnóstico de GBM pode ser desafiador, e é baseado principalmente na confirmação histopatológica do tumor excisado. Descrevemos o caso de uma paciente do sexo feminino, de 76 anos, previamente hígida, que se apresentou em nosso hospital devido a distúrbios da fala e alterações cognitivas. O diagnóstico do tipo de tumor na ressonância magnética foi difícil, pois os achados eram sugestivos de meningioma maligno devido ao realce heterogêneo de uma massa dural com um sinal de cauda dural. Além disso, os achados intraoperatórios revelaram uma massa extra-axial aderida à dura-máter. O exame histológico confirmou o diagnóstico de glioblastoma com infiltração aracnoide. A paciente foi submetida a radioterapia adjuvante e tratamento concomitante com temozolomida, apresentou melhora clínica no pós-operatório, e manteve-se estável durante os seis meses de seguimento. O glioblastoma deve ser considerado no diagnóstico diferencial de massa extra-axial primária com características atípicas e malignas, especialmente em pacientes idosos.

Keywords

brain neoplasms - glioblastoma - arachnoid - extra-axial

Palavras-chave

neoplasias cerebrais - glioblastoma - aracnoide - extra-axial

Publikationsverlauf

Eingereicht: 12. Dezember 2020

Angenommen: 22. Februar 2021

Artikel online veröffentlicht:
03. August 2021

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