Exceptional metastatic glioblastoma: A case report of multifocal spread

Glioblastomas are aggressive primary brain tumors known for their local invasiveness but rarely associated with systemic metastases. We present a rare case of a 36-year-old male initially diagnosed with a spinal pilocytic astrocytoma (WHO grade I) following a traumatic event in 2018. Despite incomplete surgical resection and refusal of adjuvant therapy, the disease remained stable under surveillance for several years. In 2023, the patient developed neurological deterioration, dyspnea, and bilateral pleural effusion. Biopsy revealed transformation into a high-grade, IDH-wildtype astrocytic tumor with extensive metastases to pleura, lymph nodes, and bones. Imaging confirmed recurrence at the spinal level with widespread extension to the thoracic wall, paravertebral muscles, and multiple skeletal sites. Multidisciplinary evaluation led to palliative treatment with temozolomide and decompressive radiotherapy. Although transient symptomatic relief was achieved, disease progression was rapid, and the patient succumbed within three months. This case illustrates the potential for malignant transformation of low-grade gliomas and the exceptional occurrence of extracranial metastases in glioblastoma. Factors such as surgical disruption of anatomical barriers and genetic alterations may contribute to metastatic spread. Early intervention and careful surveillance in patients with incompletely resected tumors are crucial. Histological confirmation remains essential for diagnosis, and treatment in metastatic settings is primarily palliative