Spinal Intramedullary Glioblastoma In A Patient Previously Irradiated For Childhood Head And Neck Embryonal Rhabdomysarcoma: Case Report And Review Of The Literature

Spinal intramedullary glioblastoma localized in cervical spinal tract has rarely been reported in the literature. The most characteristic features are a rapid clinical and radiographic progression and a very poor prognosis. We report a case of a 37year old man with a diagnosis of cervical spinal intramedullary glioblastoma, with a previous oncological history of a childhood head and neck ('epypharyngeal) embryonal rabdomyosarcoma, treated with chemoradiation therapy in our Department in 1982. The current presentation was with paresthesias/dysethesias on the left side without motor weakness; a brain and spinal MRI showed a contrast enhancing intramedullary lesion at the C2-C5 level, but no evidence of intra-cerebral disease. Biopsy of the intramedullary lesion by C2-C5 laminectomy was performed and cytological analysis revealed a glioblastoma. Radiation treatment was planned with a total dose of 54 Gy to be given in 27 fractions; unfortunately clinical deterioration at a total dose of 32 Gy was noted. Patient developed respiratory distress potentially related to the involvement of respiratory centres; patients died two days after the development of respiratory symptoms.There is little information about cervical spinal intramedullary glioblastoma in the literature and more studies are needed.