10079-CS-7 An autopsy case of glioblastoma with rapid systemic metastasis

Abstract Introduction Extracranial metastasis of a glioblastoma (GBM) is rare (0.4 to 2%). And its pathology and standard therapy has been not been established. We report a case of systemic metastasis detected 3 months after craniotomy for newly diagnosed GBM with autopsy findings. Case A 56-year-old woman presented with the progression of speech disorder. Brain MRI revealed tumor in the left temporal lobe and whole-body CT scan and blood tests showed no evidence of carcinoma. The tumor was subtotal removed. The pathological diagnosis was GBM, IDH-wild type, WHO grade 4 (MGMT methylated, GFAP (+), OLIG2 (+),). Stupp Regimen and bevacizumab were initiated, and the patient was discharged 2.5 months after surgery followed by chemotherapy as an outpatient. At 3months after surgery, her liver dysfunction rapidly progressed, and multiple nodules were found in the liver. A biopsy of the liver lesion showed that primitive tumor cells, both GFAP and OLIG2 negative, confirming that the lesion was a metastasis of GBM. She died of liver failure 4.5 months days after surgery. An autopsy revealed the primary tumor was disseminated to the central nerve system, and metastasized to the liver, the lungs, cardiovascular system, bone marrow, and lymph nodes. Discussion It is known that the most common sites of extracranial metastasis of GBM are to be bones, lymph nodes, lungs, and liver. The average duration from diagnosis of metastasis to death is 4 months, but for liver metastasis, it is shorter at 1.5 months compared to other organs. In the present case, the cause of death was rapid progression of liver failure. In recent years, there have been a number of reports of genetic analysis of GBM with extracranial metastasis. Since there have been few reports of autopsy in the previous literature, further analysis would be useful to elucidate pathogenesis and develop treatment option.