Leptomeningeal infiltration by glioblastoma multiformis of cervico-thoracic region of the spinal cord

Estudo anátomo-clínico de caso de paciente com glioblastoma multiforme da porção cervicotorácica da medula espinhal. A partir da sede primitiva o tumor invadia o espaço sub-aracnóideo, formando manguito que envolvia a medula desde a dilatação cervical até a região lombar. Apesar do crescimento tão extenso no espaço sub-aracnóideo, não foram encontradas metástases leptomeníngeas à distância. Considerações são feitas sobre a freqüência com que o glioblastoma é observado entre os tumores medulares e sobre os modos pelos quais esse glioma costuma invadir as leptomeninges. Também no caso registrado foi verificada hipoglicorraquia, achado relatado com certa freqüência no comprometimento leptomeníngeo por neoplasias. The case of a 17 year old patient with glioblastoma multiformis of cervico-thoracic region of the spinal cord whose disease was first manifested almost 7 months prior to death is reported. Initial symptoms of sphincter disfunction were soon followed by clinical signs of transverse myelopathy in the upper thoracic region. A complete block of the spinal canal was found on manometric tests. The cerebrospinal fluid was xanthochromic and coagulated immediatly; total protein concentration was markedly increased and glycosis content was low. Descendent perimyelography showed that blocking was complete at the level of first thoracic vertebral body and that it was caused by an intramedullar expanding process. About two months before death symptoms referred to spinal cord impairment assumed an ascending character. Signs of peripheral motor neuron impairment appeared in the upper extremities. Progressive signs of intracranial hypertension appeared and preceeded death. A transient cardiac arrest and apnea occured. The patient, maintained under artificial respiration, remained in comatous state until death, two days later. Brain edema was found at post-morten examination. Cerebral meninges were normal. The upper portions of the spinal cord were enlarged and their consistency was increased. The structures of the inferior portion of cervical region were completely substituted by neoplasic tissue. The central portion of cervical enlargement as well as the upper and middle portions of thoracic region were also invaded by neoplasic tissue. Ischaemic necrosis occurred in the first cervical segments. Histologic examination showed that the tumor was a glioblastoma multiformis. In the inferior portion of cervical cord the neoplasy invaded the leptomeninges, growing extensively in the subarachnoid space, surrounding the spinal cord. Nerve roots were also invaded by neoplasic tissue. Literature data concerning to the low incidence of glioblastoma among tumors of the spinal cord were quoted. The leptomemeningeal invasion by the tumor found was discussed. In spite of its extension, meningeal gliomatosis was discarded since subarachnoid and medullar portions of the tumor were continuous, no metastatic tumoral growths related to other areas of subarachnoid space were found and tumor cells were not found in the cerebrospinal fluid.