OBJECTIVES: Glioblastoma multiforme (GBM) is a highly malignant primary brain tumor in which the reported frequency of extracranial metastasis is only 0. 44%. We report a patient with lymph node and liver metastasis from a left parieto-occipital  GBM approximately 30 months from diagnosis. To the best of our knowledge, this is the first documented report of extracranial metastasis from a GBM in the Philippines.

CASE REPORT: The patient is a 51-year-oid, male witin GBM,left parieto-occipital area post gross total excision followed by concomitant radiotherapy plus Temozolomide and adjuvant Temozolomide for 6 months. Eleven months after diagnosis, he was enrolled in a Clinical Trial of lmmunotherapy Peptide Vaccine and received a total of 3 doses of the said vaccine but went of study because of a presumed recurrence. Another craniotomy and excision of the mass was performed. He continued to receive Temozolomide on a metronomic schedule. He remained well with a Karnofsky Performance Score (KPS) of 100 until 20 months post diagnosis when he developed another recurrence and underwent another craniotomy followed by Erlotinib (Tarceeva) and Carboplatin chemotherapy. He again remained well for 10months unti 30 months post-diagnosis when a left cervical mass was noted. No other extracranial lesion was seen on PET CT Scan. A biopsy of the mass had immuno-histochemical staining showing positive immunoreactivity for glial fibrillary acid protein(GFAP), CK, CK7, S 100 and Vimentin. Thirty-six months post- diagnosis, multiple enhancing ring lesions in the liver were found on CT scan. A liver biopsy was consistent with metastatic GBM.

CONCLUSION: The patient's clinical presentation and course, biopsy & Immuno-histochemical analysis ofthe lymph node and liver nodules confirmed a metastasis of GBM.