Presentation
History of glioblastoma. Pathological fracture of L4.
Patient Data
Large lytic lesion within the L4 vertebra. Another large lytic lesion within the T10 vertebra into the vertebral canal.
Bilateral multifocal lung soft tissue masses at the right lower lobe and left upper lobe. There is also a left diaphragmatic/epicardial nodule. Enlarged right hilar and left mediastinal lymph nodes.
Large mass or cluster of lesions in segment 4 of the liver. No bile duct dilatation.
Mild rectal thickening of the left lower rectum.
Case Discussion
This is a rare case of likely extraneural metastatic glioblastoma. The patient was diagnosed with IDH-wildtype glioblastoma one year prior to this scan and had undergone two surgical resections, but declined standard chemotherapy and had radiotherapy alone in a delayed fashion.
A core biopsy was obtained from the liver lesion, which demonstrated limited quantities of a malignant spindle cell malignancy. Metastatic glioblastoma is rare but favored in this case given the history of glioblastoma. The other differential diagnosis for the histological appearance is metastatic melanoma. Unfortunately, next-generation sequencing did not find genetic variations that can help with the differentiation of the two diagnoses.
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