Systematic review of primary intracranial glioblastoma multiforme with symptomatic spinal metastases, with two illustrative patients.

Glioblastoma multiforme is a malignant tumour with a universally fatal diagnosis. We report two patients with glioblastoma with symptomatic metastasis to the spinal cord and perform a systematic review all 35 reports of symptomatic glioblastoma dissemination to the spinal leptomeninges and/or intramedullary spinal axis. Our analysis of the data shows a median time to spinal metastasis of 10 months and a median time of three months from spinal metastasis to death. Treatments described include palliative laminectomies, radiotherapy and chemotherapy. No treatment strategy offered a therapeutic advantage as patients deteriorated rapidly regardless of intervention. Patients who underwent only a biopsy for intracranial glioblastoma had a shorter time to development of spinal metastasis. In addition, there may be an association between intramedullary metastasis and shorter survival. This paper highlights the importance of considering symptomatic spinal dissemination in glioblastoma multiforme. We also review the incidence and postulate mechanisms of tumour dissemination in the central nervous system. Clearly, further research into radiotherapeutic and chemotherapeutic options in this clinical setting is required.

Primary Ewing's sarcoma affecting the central nervous system: a review and proposed prognostic considerations.

Ewing's sarcoma (ES) is a part of a larger family of round blue cell tumors, which occasionally manifest as osseous or extraosseous lesions adjacent to or within the central nervous system (CNS). While a large body of literature exists on ES of bone, data are lacking on tumors with cranial or spinal components that affect the CNS. Here, we perform a systematic review of the literature and summarize the best available evidence on diagnosis, treatment and outcomes of ES affecting the CNS with emphasis on the breadth of clinical presentations, diagnostic tools and emerging management options for these rare and challenging lesions. We include a review of known prognostic factors and propose several new considerations for prognostication of ES affecting the CNS.

Sellar glomangioma.

Glomus tumors of the sellar region are exceedingly rare with only two reported cases in the literature. A case of a sellar glomangioma in a 72-year-old man is described. The tumor had the radiographic and gross appearance of a pituitary adenoma. Microscopically, the tumor was composed of epithelioid cells surrounding prominent small vascular channels. The tumor cells had indistinct cell borders and monotonous nuclei. Histological and immunohistochemical analysis identified the sellar tumor as a glomangioma. Here, we report the clinicopathological features of a third case of a sellar glomus tumor and review the literature.