PMC7238297_01
Magnetic resonance imaging of the brain when the tumor was diagnosed. In
(A) and (B), we can see the first magnetic resonance imaging that the
patient underwent when he discovered the grade III anaplastic
astrocytoma. In (C) and (D), we can view the perfusion magnetic
resonance imaging with the surrounding edema and the peripheral contrast
hypercapnia, indicating a malignant neoplasm. In (E) we can observe a
hematoxylin and eosin staining of the first resection of the central
nervous system lesion. Here, we can note the gemistocytic astrocyte'
proliferation, with mild-to-moderate pleomorphism. In (F) and (G), we
can observe the first magnetic resonance imaging the patient underwent,
which suggests the grade III anaplastic astrocytoma had already
progressed to a glioblastoma.
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These findings suggested an associated neoplasm in the same area where the hemorrhagic changes were found (Figure 1). Representative sections of the patient's stereotactic biopsy were stained with hematoxylin and eosin; a small area with a diffuse and rich proliferation of gemistocytic astrocytes could be observed (Figure 1E).
Magnetic resonance imaging of the thoracic spine and neck. In (A), we can
see the magnetic resonance imaging of the thoracic spine, wherein a
pathologic fracture of the ninth thoracic vertebral body was diagnosed
with spinal cord compression. The biopsy of the T9 vertebral body mass
diagnosed glioblastoma metastasis in this vertebral body. In (B), we can
view the magnetic resonance imaging of the neck, wherein we can observe
an augmentation in the anterior neck tissue; the lymph node biopsy,
together with immunohistochemistry studies, also diagnosed with
metastasis from the glioblastoma. In (C), we can note neoplastic
gemistocytic proliferation infiltrating the skin. In (D), the neoplastic
cells diffuse the glial fibrillary acidic protein positivity, whereas
(E) shows Ki-67positive cells.
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Therefore, he was asked to undergo a lymph node biopsy, which also showed glioblastoma metastasis (Figure 2). IDH-1R132H negative, and displayed a proliferation index of 8% (Ki-67) (Figure 2C-E). In addition, the diagnosis showed a grade III anaplastic astrocytoma (World Health Organization).
Characterization of glioblastoma cells isolated from the spinal cord
metastasis. In (A) and (B), we can observe the met-GBM18 primary cells
that were isolated from the patient in his last surgery for
decompression, and stained for glial fibrillary acidic protein as well
as S100beta in order to confirm their glial origins. In (C), we can view a
cell staining for SOX-2, which is a stem cell marker demonstrating that
this cell line has properties identical to cancer stem cells. In (D), we
can see a cell staining for vimentin, which demonstrates that this cell
line possesses epithelial-mesenchymal transition properties that are
closely related to its capacity to migrate and undergo metastasis. In
(E), we can note a cell staining for nestin, demonstrating its neural
origin. In (F), we cannot observe any staining for HIV, as expected.. HIV, human immunodeficiency virus.
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Subsequently, the patient underwent a new palliative surgical procedure to decompress the spinal cord, along with the debridement of the spine canal, as a result of which we managed to isolate his cancer cells (Figure 3). When the patient underwent a palliative spine surgery for decompression 2 years after disease onset, his metastatic glioblastoma (met-GBM18) cells were isolated, established, and characterized in our laboratory (Figure 3).