Early extracranial dissemination with prolonged survival in IDH-wildtype glioblastoma: case study and comprehensive literature review

BACKGROUND: Extracranial metastasis of glioblastoma (GBM) is rare (0.4-2%) and associated with poor prognosis. For this report, "early extracranial dissemination" is defined as radiographically and histologically confirmed metastatic disease identified at or within one month of the index GBM diagnosis, distinguishing it from metastasis arising later in the disease course. CASE PRESENTATION: A 65-year-old woman with IDH-wildtype, MGMT-methylated GBM presented with seizures, right hemiplegia, and expressive aphasia. She underwent near-total resection followed by chemoradiotherapy with temozolomide. A suspicious right lower lobe pulmonary lesion was identified on initial staging, and biopsy-confirmed GBM involving mediastinal lymph nodes was established within one month of diagnosis. Despite pulmonary and mediastinal involvement, intracranial hemorrhage, seizures, and venous thromboembolism, she survived 25 months from diagnosis and 24 months following confirmation of metastatic disease. DISCUSSION: This case is notable for exceptionally early extracranial dissemination, pulmonary and mediastinal involvement, and prolonged post-metastatic survival. MGMT methylation and sustained temozolomide therapy may have contributed to disease control, although these observations remain hypothesis-generating. CONCLUSION: Early extracranial dissemination may be underrecognized and warrants further investigation through risk-stratified approaches to extracranial surveillance.