[Secondary localizations of cerebral glioblastoma. Pathogenic and anatomoclinical focus apropos of a case of multiple bone metastases disclosed by vertebral involvement].

This report describes a case of a cerebral glioblastoma with multiple metastases appeared two years after craniotomy and revealed by a diffuse vertebral involvement with a lumbo-sciatic pain. The experimental and clinical data from the literature about distant localizations of glioblastoma give the arguments for the rarity and the pathogenic modes of the natural course. The distant localizations of cerebral glioblastoma, identified by immunohistochemical staining for glial fibrillary acidic protein, occurred in young patients, late in the follow-up which the duration is longer than those of classical glioblastomas; their occurrence hasten the disease course. Two distinct oncological entities might be identified: metastases, using blood or lymphatic pathways, commonly from a supra-tentorial primary tumor, are facilitated by surgical treatment; their exclusive extraneural sites are usually symptomatic; grafts, by seeding via cerebrospinal fluid pathways, are spontaneous or facilitated by tumoral removal and are disseminated along the neuraxis; they occur frequently and are usually asymptomatic; when shunts induce them, it gives rise to symptomatic peritoneal seeding; they seem to concern poor invading primary glioblastomas. The extraneural (metastasis) or neuraxial (graft) sites and the ways of occurrence (spontaneous, or facilitated by craniotomy or induced by surgical shunts) allow to classify the distant localizations of glioblastoma in six pathogenic types.