Multiple vertebral metastases from brain glioblastoma: An insidious complication

Glioblastoma (GBM) is the most malignant and the most frequent of primary astrocytomas, typically involving the Central Nervous System (CNS) alone. Extra-CNS localizations (ECM) are exceptional, and vertebral dissemination is extremely uncommon. We present the case of a patient with vertebral dissemination from an intracranial GBM without intra-dural space invasion. The patient underwent a gross total tumor removal followed by radiation therapy (RT) with concomitant temozolomide chemotherapy (STUPP protocol). Following the appearance of back pain, patient underwent whole body computed tomography (CT) and spinal magnetic resonance imaging (MRI) scan. Spinal-MRI highlighted multiple vertebral lesions not infiltrating dura mater being confined to vertebral bodies. CT scan demonstrated the absence of other repetitive lesions in both thorax and abdomen. Histological examination from a percutaneous CT-guided vertebral biopsy confirmed the suspicious of secondary localization from intracranial GBM. To the best of our knowledge this is the second reported case of vertebral metastases from GBM in absence of other ECM. This case raises the need for clinical suspicious of vertebral dissemination in case of GBM patient presenting with radicular, myelopathic symptoms or less specifically, back pain.