Intracranial Dissemination of Glioblastoma Multiforme in Adults
Caterina Chiara Bianchi M.D., Donatella Tampieri M.D. F.R.C.P.C.,
Marie Christine Guiot M.D., Jeffery Hall M.D. M.Sc F.R.C.S.(C)

lioblastoma multiforme (GBM) is usually a single lesion; it tends to recur locally after treatment. However multifocal glioblastoma multiforme has been reported to occur both spontaneously or following treatment of a solitary one.
       In multifocal glioblastoma multiforme the lesions present usually close to the primary tumour site, dissemination through the central nervous system occurs rarely. We present a case of a primary multifocal intracranial GBM in a 62-year-old patient.

CASE DESCRIPTION

This is a 62-year-old female patient who was admitted in October 2005, at our hospital with progressive execution function impairment and memory problems occurring over the past two years. The magnetic resonance exam (MRI) done in June 2004 was reviewed and found negative. The symtomatology had particularly worsened in the last month. The neurological examination was completely unremarkable except for a slight ataxic gait. The present MRI demonstrated an heterogeneous space occupying lesion located in the genu of the corpus callosum extending to the anterior aspect of its body and rostrum. The lesion had

predominantly hypointense signal in T1 and hyperintense in T2 with a few areas of necrosis. Some of the lesions strongly enhanced following gadolinium injection, while one lesion in the left parietal paramedien area did not enhance. (Fig1 A,B,C,D) The lesion was associated with surrounding vasogenic edema and causing severe mass effect resulting in compression of the frontal horns of the lateral ventricles. A multitude of small additional lesions were also noted within the cerebral hemispheres and leptomeningeal spaces. (Fig1 E,F)

Figure 1. A, Axial FLAIR image showing a hyperintense heterogeneous mass crossing the corpus callosum with marked associated vasogenic edema. There is a hyperintense cortical thickening in the left precuneus without edema. B, Axial T1 weighted image with contrast demonstrating enhancement of the lesion. C, Sagittal T1 weighted image with contrast showing small areas of nodular enhancement medially in a subependymal location along the left lateral ventricle. The infundibulum and the hypothalamus are widened and enhancing. There is enhancement of the leptomeninges over the anterior surface of the brainstem and most marked at the level of the interpeduncular fossa. D, Sagittal T1 weighted image with contrast showing an other small enhancing lesion in the right frontal lobe. E, Coronal T1 weighted image with contrast showing the enhancement in the infundibulum. F, Coronal T1 weighted image with contrast showing no enhancement of the lesion in the left precuneus. There is diffuse leptomeningeal enhancement infratentorially.