DIFFUSE BONE-MARROW METASTASES FROM GLIOBLASTOMA-MULTIFORME - THE ROLE OF DURAL INVASION

Two cases of glioblastoma multiforme (GEM) diffusely metastatic to bon e marrow are presented; both patients developed back pain, thrombocyto penia, and hemorrhagic diatheses from their diffuse bony disease. In o ne patient the intracranial and extracranial symptoms were synchronous in their presentation. Both patients had known dural involvement by G EM at the time of craniotomy and dural venous invasion microscopically . Tumor infiltration of dura and dural vessels is a significant mechan ism for extracranial spread and should be noted by surgical pathologis ts in their reports if it is found. Although cases of metastatic GEM h ave been uncommon in the past, especially without antecedent surgery o r ventriculoperitoneal shunt placement, better control of local diseas e may enhance the possibility of extracranial spread in the future fro m GEM. The finding of dural invasion by GEM either at surgery or micro scopically should prompt oncologists to initiate at least a limited me tastatic work-up for this subset of GEM patients. Copyright (C) 1996 b y W.B. Saunders Company.