Metastatic Glioblastoma: A Case Report and Review of the Literature

Introduction

Glioblastoma is the most aggressive primary brain neoplasm. Despite surgical resection, chemotherapy, and radiation, local recurrence occurs with high frequency .This is, in part, due to the infiltrative growth pattern of the tumor, which often obviates any chance for complete surgical resection. While usually centered in the white matter of the cerebral hemispheres, infiltrating tumor cells frequently are present in an adjacent lobe or the opposite hemisphere as the tumor extends along the white matter tracts of the centrum semiovale, corpus callosum, and internal capsule.

A diagnosis of glioblastoma requires histological examination of the tumor.Hallmark features include hypercellularity, nuclear pleomorphism, microvascular proliferation and intravascular thrombosis.Necrosis is usually present, often with tumor cells clustering around necrotic foci, in a pseudopalisading pattern. Glioblastoma cells are immunopositive for glial fibrillary acid protein (GFAP). An immunohistochemical stain for Ki-67 (Mib-1) often shows an elevated (>10%) proliferation-related labeling index.