Diffuse

Osteoblastic STEFAN

In recent

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cranial

years,

it has

tumors

this course loblastomas primary

may

brain

become

[5,

and

in the

English

with

because

of the

frontal

right

carotid motor

grade

radiation steroids.

Fig. astrocytes.

was

in fig.

Schatzki. 2 Department

J Roentgeno/

The

scan”

case

that

Report

was

admitted

left

by

At surgery, a cystic subtotally resected. The

(fig.

1A).

(5,000 rad) and was well until September

1A

view of biopsy magnification

H and

21. 1976; of Radiology.

accepted Mount

of Neurosurgery,

128:321-323.

E, original

February

Auburn

1977

region.

of interest

all

with

in

first

to deteriorate,

he

had

and

The

peripheral

2B).

the

excellent

hemi-

sclerosis

thoracic

of spine,

bones

injection

of

delineation

almost

1976,

became left

diffuse

lumbar

4 hr after

March

sclerosis

a progressive

that

and

1974, time.

were

1 5 mCi

of

of the skeleton.

8 years

after

the

original

recurrent

astrocytoma

Sections

of iliac

metastatic of

outside

was

crest,

astrocytoma the

(fig.

peripheral

the

found

in

ribs,

and

sternum, 1B).

skeleton

the

There

and

no

right

vertebrae were

no

evidence

of

skeleton.

Discussion Primary

and

cranially.

brain The

tumors

reasons

absence

of cerebral

channels

by the

to the tumor been implicated

dilantin and a massive

frontal lobe 8. Metastatic

died

January

began

pelvis,

2A

a

A large

received

patient

noted

scan

3) showed

In the

developed

the

(figs.

taken

metastases

scan

it was

(fig.

showed

sections

The

magnification

patient

autopsy.

to the sections

of right x 400.

MDP

patient

and

A bone

for

craniotomy.

tumor anterior microscopic

showing grade Ill astrocytoma seen

astrocytoma. at autopsy.

usually for

this

lymphatics, tumor.

immune

do are

not early

metastasize

well

extra-

understood.

occlusions

response

cells, and short patient in the low incidence

Tumor consists Bone marrow

not

by other

survival [6] of metastatic

primarily of fibrillary space is filled by tumor

The

of venous organs have all disease.

and gemistocytic cells identical

to

x400

after revision October Auburn Hospital, 330 Mount

The

meta-

clavicles

At

1968

with when

and

examined.

noted

the

involving

frontal

radionuclide

treated 1972

skeleton

LOWIS2 removed.

was

1975,

At this

99mTc

example

headache.

wing

time,

not

obtained.

April

and

subtotally

iliac

plegia.

presenting

first

is also

was

in

hemipariesis

demonstrated

1 . -A. High power H and E, original

shown

the

was

obtunded,

ribs,

changes

glioma

right

Glioma

SAMUEL

progressively the

recently

or myeloid

the

In September

developed after the

skeletal

knowledge,

Case

Ill astrocytoma

therapy He did

Received July 1 Department

Am

bone

male

tumor

angiography. strip was

showed

those

“super

of progressive

The

carcinoma

lesions.

We who years

AND

recurrence of

While

metastases

osteolytic.

of a metastatic

osteoblastic

56-year-old

history

to our

osseous

an Intracranial

McILMOYLE,’

intra-

[1-6].

a patient several

a glioma.

literature

that

from

in children with medulreported in adults with

always

prostatic

represent,

diffuse

This

for

metastatic

plasia

recognized

In adults,

to follow metastases

craniotomy

mimicked

GAELLAN

extracranially

6.

and virtually

had the opportunity diffuse osteoblastic initial

well

commonly found it has also been

tumors

are not frequent

C. SCHATZKI,’

metastasize

is more [1-4],

Metastases

Hospital,

20. 1976 Mount Auburn Cambridge.

Street.

Massachusetts

321

Cambridge. 02138.

Massachusetts

02138

Address

reprint

requests

to S

C.

CASE

322

REPORTS

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p-$,

,.

..

r Fig. femurs.

2. -A Spleen

and

is not

A recent survey Forces Institute metastases cranial recent

over

during

is

felt

surgery

8,000

frequent

cases

that

showing

diffuse

have [2]. have

and

are

therefore

[6).

However,

cells have

enter the

extra-

blood

potential

a single case metastasis

usually

in after

vessels for

has been occurred

Extracranial been less lymph

of osteolytic

of metastatic

reports in

osteolytic,

occurred. has seemed

to the

sclerotic

spine

at the Armed 35 extracranial

reported more frequently all cases occurred

tumor

metastases

involving

entire

of children

diffuse

wide-

lumbar

nodes,

liver,

8],

glioma

and

from

lungs

[5].

intracranial

including [8]. Smith with

primary and are

two et

blastic

cases al. [6] changes

presented

with

a solitary

femur [9]. In our case, with

with of

neoplasm

the

spine.

pelvis,

and

proximal

ribs,

agnogenic not

metastatic

only able

in the

There

is that

metastasis

process

and

to

pelvis

that

myeloid

the

were

suggested

in-

meta-

metaplasia.

examined.

The

The

metastases

until 6 years after the first craniotomy. The in this case is unusual. If one draws a parallel of

usual

in medulloblastoma, diffuse poor

disease

and

short

or

metabolic

many institutions test for metastatic area

to differentiate

the

osteoblastic

of the

previous

metastases prognosis

that

so-called “super bone scan” can with diffuse skeletal abnormalities policy of screening

radiographs. oligodendroglioma

spine,

was

experience

the

Several

in the

or

an

sclerotic

intracranial gliomas. It has been well recognized

gliomas that prereported

entire

skeleton

a report

reflect of

the

no

of

an osteoblastic

did not occur long survival

brain more

presented

example

peripheral

osseous [1-4].

but

reported

static

osteoblastic

metastases from common in adults

at autopsy

a single

volved

reported without

The frequency of extracranial to correlate with the length

metastases

have been reported [5, sented with hypercalcemia

a case

cases

have been numerous from medulloblastomas

these

changes involvement survival tumors

craniotomy

[7].

There metastases While

original

brain tumors found only

have been 6]. Virtually

spread metastases. Only in which an extracranial surgery

after

of primary of Pathology

in

It

.,.

8 years

enlarged.

metastases years [5.

surgery.

‘

El. Films

for

a superior

lack

may

only

patients bone

with scan

or

be obtained in patients [10-12] due to diffuse disease.

to use disease

abnormal

scan,

the superior

quality

Since

it

is the

the bone scan and to obtain

as a films

is important

to be

it

scan

seen

in normal

CASE

ANT

323

REPORTS

patients

POST

static

from

under recent could

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the

disease.

super

bone

A method

these papers

circumstances [10, 13]. The

easily

have

scan

due

of recognizing

been

has super

diffuse

meta-

abnormal

scan

td

the

been well discussed bone scan in this

considered

in case

normal.

ACKNOWLEDGMENT

We thank

Dr. Karl Sorger

for

help

in preparing

the pathologic

material. REFERENCES

r’

!

. Banna

M, Lassman skeletal metastases Radiol 43:395-399, 2. Brutschin P. Culver 1

loblastor#{231}ia

LP, Pearce GW: Radiological study of from cerebellar medulloblastoma. Br J 1964 GJ: Extracranial metastases from medul-

Radiology

.

1 07 :359-362,

1973

3. DebnamJW, StapleTW: Osseous metastases from cerebellar medulloblastoma. Radiology 1 07 :363-365, 1973 4. Stolzenberg J, Fischer JJ, Kligerman MM: Extradural metastases in medulloblastoma of a case. Am J Roentgenol 5. Glasauer

FE, Yuan

AHP:

10 years after 108:71-74, Intracranial

treatment: 1970

tumors

with

report

extracranial

metastases:

case report and review of the literature. J Neurosurg 20:474-493, 1963 Smith DR. Hardman JM, Earle KM: Metastasizing neuroectodermal tumors of the central nervous system. J Neurosurg 31:50-58, 1969 Aubinstein U: Development of extracranial metastases from a malignant astrocytoma in the absence of previous craniotomy. J Neurosurg 26:542-547, 1967 Cooper PA, Budzilovich GN, Berczeller PH, Lieberman A, Battista A: Metastatic glioma associated with hypercalcemia: report of two cases. J Neurosurg 39:255-259, 1974 James TGI, Pagel W: Oligodendroglioma with extracranial metastases. Br J Surg 39:56-65, 1952

6.

7.

8.

9. 10.

4

-

Osmond

-.-

the

=

.

detection

..

-

Fig 3 -Anterior hr after injection bones

and of 99rn’c

throughout and

diminished

renal

skeleton counts

with

increased

Am

AK, in

uptake

in

distal

long

4

scan

prostate. Henkin

patterns

Potsaid

scans

breast,

and

125:972-977, RE.

Quinn

MS:

and

Accuracy

of

roentgenograms

lung

carcinoma

in meta-

1975 JL:

metastatic

disseminated

1 2. Witherspoon

HP, bone

J Roentgenol

113:383-386,

-

posterior views made with rectilinear scanner MDP demonstrating asymmetrical but increased

entire

of

Thrupkaew

scans

Pendergrass

diphosphonate

stases. 11

uptake

JD.

Tc-99m

False

disease.

negative

bone

Radiology

1974 LA,

Blonde

of patients

L, Shuler

with

SE,

McBurney

DB:

Bone

diffuse metastatic carcinoma of the axial skeleton. J Nucl Med 17:253-257, 1976 13. Sy WM, Patel D, Faunce H: Significance of absent or faint kidney sign on bone scan. J NucI Med 16:464-456, 1975