Beyond the Brain: A Case of Metastatic Astrocytoma

Astrocytomas are primary brain tumors characterized by aggressive growth and local invasion.They typically remain confined to the central nervous system (CNS), and distant metastases are extremely uncommon.We present the case of a 45-year-old man diagnosed with an isocitrate dehydrogenase (IDH)-mutant, grade 4 astrocytoma (World Health Organization (WHO) classification), who underwent gross total resection followed by adjuvant chemoradiotherapy, initially showing good clinical progress.After the fourth cycle of adjuvant temozolomide, he developed lower back pain, asthenia, and sweating that led to further investigation revealing extensive bone infiltration and an epidural paravertebral mass at the second lumbar vertebra (L2), which was histologically confirmed as bone metastasis with epidural extension and bone marrow infiltration by the astrocytoma.Due to the lack of eligibility for further curative therapies, and after multiple hospitalizations for symptom management, the patient was admitted to the Palliative Care Unit, where he ultimately passed away.This case adds to the clinical knowledge by documenting a rare presentation of IDH-mutant astrocytoma with extracranial bone metastases, a phenomenon seldom seen in gliomas.It highlights the diagnostic complexity of distinguishing between treatment-related effects and disease progression when gliomas present with systemic symptoms.Additionally, it underscores the challenges of managing advanced disease with limited treatment options and emphasizes the role of palliative care in symptom control.