Primary glioblastoma multiforme of the conus medullaris with leptomeningeal metastasis

摘要

Dear Editor, Most spinal tumours are benign, with only 10-15% showing high-grade features such as endothelial proliferation or necrosis upon histological examination [5]. Glioblastoma multiforme (GBM) represents only a subset of these, and is radically less common in the spinal cord than it is in the brain, representing only 1.4% of intraspinal tumours [5]. GBM of the conus medullaris is even rarer, having been reported in only a handful of case reports, and represents unique challenges in terms of diagnosis and management. Here, we report such a case, review the limited available evidence and discuss the management of this rare malignancy. A previously-well 31-year-old male presented with a three-week history of progressive left leg weakness and altered sensation. He denied any bowel or bladder dysfunction, and had normal perineal sensation. Subsequent MRI spine showed a T2 hyperintense lesion of the conus medullaris, expanding the cord, with a 'tail' extending rostrally to T9. There were normal appearances of the brain, cervical and upper thoracic spinal cord. This lesion was initially felt likely to be inflammatory although patchy enhancement also raised the possibility of a neoplastic lesion. A trial of steroids was commenced and the possibility of biopsy discussed. However, the risks of this procedure were felt to outweigh the benefits at this time, and it was decided to monitor the lesion clinically with regular follow-up. Unfortunately, 4 months later, the patient re-presented with further deterioration of his neurological function, including right leg weakness and urinary retention. Given his acute decompensation, it was felt prudent to proceed to surgery to decompress the thecal sac, debulk the lesion and obtain tissue for histological analysis.