Öz
Glioblastoma multiforme (GBM) is know as most common and aggressive malignant tumor among brain tumors. Originating from high-grade malignant glial cells, this tumor tends to be localized within the brain. However, extracranial metastases of GBM are extremely rare. Extracranial metastases are generally observed in organs such as lungs, liver and lymph nodes in treatment-resistant cases, usually in advanced stages of the disease. However, metastases may rarely occur in bone, skin and other organs. The presence of extracranial metastases is an important prognostic factor, indicating that the disease has become more biologically aggressive. Extracranial metastases occur with symptoms in some organs other than the brain, making the metastasis treatment and process very difficult. While the possibility of extracranial metastases seems unlikely due to the presence of the blood-brain barrier, it has been evaluated that the the incidence of extracranial metastases is between 0.5-2% in some clinical cases.
Clinical trials have demonstrated that GBM patients with extracranial metastases have reduced survival and are less responsive to treatment. This is attributable to the refractory nature of metastases and the potential for metastases to go undetected due to the limited survival of patients, which complicates effective disease management.
The utilization of advanced imaging techniques and systemic treatment modalities are of paramount importance in the diagnosis and treatment processes. However, there is currently a paucity of standardised protocols for the treatment of GBM metastases. Further clinical research on extracranial metastases of GBM will facilitate the development of more effective treatment strategies.
Anahtar Kelimeler
glioblastoma multiforme brain tumors extracranial metastasis
Kaynakça
- Cartwright JHE, Escribano B, González DL, Sainz-Díaz CI, Tuval I. Brinicles as a case of inverse chemical gardens. Langmuir. 2013;29(25): 7655-60.
- Gómez-Lozada F, del Valle CA, Jiménez-Paz JD, Lazarov BS, Galvis J. Modelling and simulation of brinicle formation. R Soc Open Sci. 2023;10(10).
- Deshmukh V, Pathan NS, Haldar N, Nalawade S, Narwade M, Gajbhiye KR, et al. Exploring intranasal drug delivery via nanocarriers: A promising glioblastoma therapy. Colloids Surf B Biointerfaces. 2025 Jan;245:114285.
- Strong MJ, Koduri S, Allison JA, Pesavento CM, Ogunsola S, Ogunsola O, et al. Bone metastasis from glioblastoma: a systematic review. Vol. 158, Journal of Neuro-Oncology. 2022: 379-392.
- Kurdi M, Baeesa S, Okal F, Bamaga AK, Faizo E, Fathaddin AA, et al. Extracranial metastasis of brain glioblastoma outside CNS: Pathogenesis revisited. Vol. 6, Cancer Reports. 2023: e1905.
- Davis L. Spongioblastoma multiforme of the brain. Ann Surg. 1928 Jan;87(1):8–14.
- Lun M, Lok E, Gautam S, Wu E, Wong ET. The natural history of extracranial metastasis from glioblastoma multiforme. J Neurooncol. 2011;105(2): 361-73.
- Garret R. Glioblastoma and fibrosarcoma of the brain with extracranial metastases. Cancer. 1958;11(5): 888-94.
- Huang WZ, Chen HC, Chang TK, You WC, Jan YJ, Chou YC. Extracranial metastasis of pediatric glioblastoma: case report and literature review. Child’s Nervous System. 2024;40(3): 933-937.
- Goodwin CR, Liang L, Abu-Bonsrah N, Hdeib A, Elder BD, Kosztowski T, et al. Extraneural Glioblastoma Multiforme Vertebral Metastasis. Vol. 89, World Neurosurgery. 2016: 578-582.e3.
- Paget S. The distribution of secondary growths in cancer of the breast. The Lancet. 1889;133(3421): 98-101.
- Zidan MA, Hassan RS, El-Noueam KI, Zakaria YM. Brain metastases assessment by FDG-PET/CT: can it eliminate the necessity for dedicated brain imaging? Egyptian Journal of Radiology and Nuclear Medicine. 2020;51(1): 1-11.
- Ghous G, Miller D, Doll D, Tuncer T. A rare case of glioblastoma with extensive liver metastases. ONCOLOGY (United States). 2021;(3511): 733-740.
- Ray A, Manjila S, Hdeib AM, Radhakrishnan A, Nock CJ, Cohen ML, et al. Extracranial metastasis of gliobastoma: Three illustrative cases and current review of the molecular pathology and management strategies. Mol Clin Oncol. 2015;3(3): 479-486.
- Briones-Claudett KH, Briones-Claudett MH, Garcia FV, Almeida CO, Escudero-Requena A, Solís JB, et al. Early pulmonary metastasis after a surgical resection of glioblastoma multiforme. A case report. American Journal of Case Reports. 2020;21: e922976-1-e922976-5.
- Armanios MY, Grossman SA, Yang SC, White B, Perry A, Burger PC, et al. Transmission of glioblastoma multiforme following bilateral lung transplantation from an affected donor: Case study and review of the literature. Neuro Oncol. 2004;6(3): 259-263.
- Frank S, Kuhn SA, Brodhun M, Mueller U, Romeike B, Kosmehl H, et al. Metastatic glioblastoma cells use common pathways via blood and lymphatic vessels. Neurol Neurochir Pol. 2009;43(2):183–90.
- Piccirilli M, Brunetto GMF, Rocchi G, Giangaspero F, Salvati M. Extra central nervous system metastases from cerebral glioblastoma multiforme in elderly patients. Clinico-pathological remarks on our series of seven cases and critical review of the literature. Tumori. 2008;94(1): 40-51.
- Swinnen J, Gelin G, Fransis S, Vandevenne J, Van Cauter S. Glioblastoma with extracranial parotid, lymph node, and pulmonary metastases: a case report. Radiol Case Rep. 2019;14(11): 1334-1347.
- Kanemitsu T, Furuse M, Kuwabara H, Yagi R, Hiramatsu R, Kameda M, et al. Increasing C-reactive protein levels in a patient with glioblastoma with lymph node metastasis: a case report. BMC Neurol. 2023;23(1): 354.
- López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, et al. Cervical lymph node metastases from remote primary tumor sites. Vol. 38, Head and Neck. 2016: E2374-85.
- Momota H, Narita Y, Miyakita Y, Shibui S. Secondary hematological malignancies associated with temozolomide in patients with glioma. Neuro Oncol. 2013;15(10): 1445-50.
- Robert MC, Wastie ME. Glioblastoma multiforme: A rare manifestation of extensive liver and bone metastases. Biomed Imaging Interv J. 2008;4(1): e3.
- Mihara F, Ikeda M, Rothman MI, Numaguchi Y, Kristt D. Vertebral body metastasis of glioblastoma multiforme with epidural mass formation contrast enhanced MRI study. Clin Imaging. 1994;18(4): 386-9.
- Hsu E, Keene D, Ventureyra E, Matzinger MA, Jimenez C, Wang HS, et al. Bone marrow metastasis in astrocytic gliomata. J Neurooncol. 1998;37(3): 285-93.
- Ramakrishna R, Rostomily R. Seed, soil, and beyond: The basic biology of brain metastasis. Surg Neurol Int. 2013;4(SUPPL4): S256-S364.
- Holdhoff M, Yovino SG, Boadu O, Grossman SA. Blood-based biomarkers for malignant gliomas. Vol. 113, Journal of Neuro-Oncology. 2013: 345-352.
- Aldape K, Zadeh G, Mansouri S, Reifenberger G, von Deimling A. Glioblastoma: pathology, molecular mechanisms and markers. Vol. 129, Acta Neuropathologica. 2015: 829-48
- Greenhall GHB, Rous BA, Robb ML, Brown C, Hardman G, Hilton RM, et al. Organ Transplants from Deceased Donors with Primary Brain Tumors and Risk of Cancer Transmission. JAMA Surg. 2023;158(5): 504-513.
Öz
Glioblastoma multiforme (GBM), beyin tümörleri arasında en sık görülen ve en agresif malign tümör olarak bilinir. Yüksek dereceli malign glial hücrelerden kaynaklanan bu tümör, beyin içinde lokalize olma eğilimindedir. Bununla birlikte, GBM’nin ekstrakraniyal metastazları son derece nadir görülmektedir. Genellikle hastalığın ileri evrelerinde, tedaviye dirençli vakalarda akciğerler, karaciğer ve lenf nodülleri gibi organlarda ortaya çıkabilmektedir. Ancak metastazlar, nadiren de olsa kemik, deri ve diğer organlarda da ortaya çıkabilir. Ekstrakraniyal metastazların varlığı, hastalığın biyolojik olarak daha agresif bir hal aldığını gösteren önemli bir prognostik faktördür. Ekstrakraniyal metastazlar beynin dışında bazı organlarda semptomlarla ortaya çıkmaktadır ki bu metastazın tedavisi ve sürecini oldukça zorlaştırır. Kan beyin bariyerinin varlığı nedeniyle ekstrakraniyal metastazların gerçekleşme ihtimali mümkün görünmezken, günümüzde bazı klinik vakalarda ekstrakraniyal metastazlarının görülme oranının %0.5-2 arasında olduğu değerlendirilmiştir. Klinik çalışmalar, ekstrakraniyal metastazları olan GBM hastalarının daha kısa yaşam sürelerine sahip olduğunu ve tedaviye daha az yanıt verdiklerini ortaya koymaktadır. Bu durum, metastazların tedaviye karşı dirençli doğası, hasta sağkalımının kısa olmasından dolayı metastazların fark edilemeyişi ve hastalığın kontrol altına alınmasının zorluğundan kaynaklanmaktadır. Tanı ve tedavi süreçlerinde, ileri görüntüleme teknikleri ve sistemik tedavi yöntemleri önemlidir. Ancak günümüzde GBM metastaz tedavisi için standart bir protokolü bulunmamaktadır. Bununla birlikte, GBM’nin ekstrakraniyal metastazları üzerine daha fazla klinik araştırma yapılması, tedaviye yönelik daha etkili stratejilerin geliştirilmesine olanak sağlayacaktır.
Anahtar Kelimeler
glioblastoma multiforme beyin tümörü ekstrakraniyal metastaz
Kaynakça
- Cartwright JHE, Escribano B, González DL, Sainz-Díaz CI, Tuval I. Brinicles as a case of inverse chemical gardens. Langmuir. 2013;29(25): 7655-60.
- Gómez-Lozada F, del Valle CA, Jiménez-Paz JD, Lazarov BS, Galvis J. Modelling and simulation of brinicle formation. R Soc Open Sci. 2023;10(10).
- Deshmukh V, Pathan NS, Haldar N, Nalawade S, Narwade M, Gajbhiye KR, et al. Exploring intranasal drug delivery via nanocarriers: A promising glioblastoma therapy. Colloids Surf B Biointerfaces. 2025 Jan;245:114285.
- Strong MJ, Koduri S, Allison JA, Pesavento CM, Ogunsola S, Ogunsola O, et al. Bone metastasis from glioblastoma: a systematic review. Vol. 158, Journal of Neuro-Oncology. 2022: 379-392.
- Kurdi M, Baeesa S, Okal F, Bamaga AK, Faizo E, Fathaddin AA, et al. Extracranial metastasis of brain glioblastoma outside CNS: Pathogenesis revisited. Vol. 6, Cancer Reports. 2023: e1905.
- Davis L. Spongioblastoma multiforme of the brain. Ann Surg. 1928 Jan;87(1):8–14.
- Lun M, Lok E, Gautam S, Wu E, Wong ET. The natural history of extracranial metastasis from glioblastoma multiforme. J Neurooncol. 2011;105(2): 361-73.
- Garret R. Glioblastoma and fibrosarcoma of the brain with extracranial metastases. Cancer. 1958;11(5): 888-94.
- Huang WZ, Chen HC, Chang TK, You WC, Jan YJ, Chou YC. Extracranial metastasis of pediatric glioblastoma: case report and literature review. Child’s Nervous System. 2024;40(3): 933-937.
- Goodwin CR, Liang L, Abu-Bonsrah N, Hdeib A, Elder BD, Kosztowski T, et al. Extraneural Glioblastoma Multiforme Vertebral Metastasis. Vol. 89, World Neurosurgery. 2016: 578-582.e3.
- Paget S. The distribution of secondary growths in cancer of the breast. The Lancet. 1889;133(3421): 98-101.
- Zidan MA, Hassan RS, El-Noueam KI, Zakaria YM. Brain metastases assessment by FDG-PET/CT: can it eliminate the necessity for dedicated brain imaging? Egyptian Journal of Radiology and Nuclear Medicine. 2020;51(1): 1-11.
- Ghous G, Miller D, Doll D, Tuncer T. A rare case of glioblastoma with extensive liver metastases. ONCOLOGY (United States). 2021;(3511): 733-740.
- Ray A, Manjila S, Hdeib AM, Radhakrishnan A, Nock CJ, Cohen ML, et al. Extracranial metastasis of gliobastoma: Three illustrative cases and current review of the molecular pathology and management strategies. Mol Clin Oncol. 2015;3(3): 479-486.
- Briones-Claudett KH, Briones-Claudett MH, Garcia FV, Almeida CO, Escudero-Requena A, Solís JB, et al. Early pulmonary metastasis after a surgical resection of glioblastoma multiforme. A case report. American Journal of Case Reports. 2020;21: e922976-1-e922976-5.
- Armanios MY, Grossman SA, Yang SC, White B, Perry A, Burger PC, et al. Transmission of glioblastoma multiforme following bilateral lung transplantation from an affected donor: Case study and review of the literature. Neuro Oncol. 2004;6(3): 259-263.
- Frank S, Kuhn SA, Brodhun M, Mueller U, Romeike B, Kosmehl H, et al. Metastatic glioblastoma cells use common pathways via blood and lymphatic vessels. Neurol Neurochir Pol. 2009;43(2):183–90.
- Piccirilli M, Brunetto GMF, Rocchi G, Giangaspero F, Salvati M. Extra central nervous system metastases from cerebral glioblastoma multiforme in elderly patients. Clinico-pathological remarks on our series of seven cases and critical review of the literature. Tumori. 2008;94(1): 40-51.
- Swinnen J, Gelin G, Fransis S, Vandevenne J, Van Cauter S. Glioblastoma with extracranial parotid, lymph node, and pulmonary metastases: a case report. Radiol Case Rep. 2019;14(11): 1334-1347.
- Kanemitsu T, Furuse M, Kuwabara H, Yagi R, Hiramatsu R, Kameda M, et al. Increasing C-reactive protein levels in a patient with glioblastoma with lymph node metastasis: a case report. BMC Neurol. 2023;23(1): 354.
- López F, Rodrigo JP, Silver CE, Haigentz M, Bishop JA, Strojan P, et al. Cervical lymph node metastases from remote primary tumor sites. Vol. 38, Head and Neck. 2016: E2374-85.
- Momota H, Narita Y, Miyakita Y, Shibui S. Secondary hematological malignancies associated with temozolomide in patients with glioma. Neuro Oncol. 2013;15(10): 1445-50.
- Robert MC, Wastie ME. Glioblastoma multiforme: A rare manifestation of extensive liver and bone metastases. Biomed Imaging Interv J. 2008;4(1): e3.
- Mihara F, Ikeda M, Rothman MI, Numaguchi Y, Kristt D. Vertebral body metastasis of glioblastoma multiforme with epidural mass formation contrast enhanced MRI study. Clin Imaging. 1994;18(4): 386-9.
- Hsu E, Keene D, Ventureyra E, Matzinger MA, Jimenez C, Wang HS, et al. Bone marrow metastasis in astrocytic gliomata. J Neurooncol. 1998;37(3): 285-93.
- Ramakrishna R, Rostomily R. Seed, soil, and beyond: The basic biology of brain metastasis. Surg Neurol Int. 2013;4(SUPPL4): S256-S364.
- Holdhoff M, Yovino SG, Boadu O, Grossman SA. Blood-based biomarkers for malignant gliomas. Vol. 113, Journal of Neuro-Oncology. 2013: 345-352.
- Aldape K, Zadeh G, Mansouri S, Reifenberger G, von Deimling A. Glioblastoma: pathology, molecular mechanisms and markers. Vol. 129, Acta Neuropathologica. 2015: 829-48
- Greenhall GHB, Rous BA, Robb ML, Brown C, Hardman G, Hilton RM, et al. Organ Transplants from Deceased Donors with Primary Brain Tumors and Risk of Cancer Transmission. JAMA Surg. 2023;158(5): 504-513.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Beyin ve Sinir Cerrahisi (Nöroşirurji), Kanser Hücre Biyolojisi |
| Bölüm | Derlemeler |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Mart 2025 |
| Gönderilme Tarihi | 15 Ocak 2025 |
| Kabul Tarihi | 3 Şubat 2025 |
| Yayımlandığı Sayı | Yıl 2025Cilt: 64 Sayı: 1 |
