ChiIdhood GIioblastoma Multiforme Mimicking BasaI Meningitis -Report of An Autopsy Case-

Abstract

Glioblastoma multiforme is a highly malignant neuroglial tumor rarely reported in children with several differences compared to the adult tumor. Its clinical diagnosis is sometimes difficult because most children do not have an antecedant history to herald the development of the tumor. We report a case of glioblastoma multiforme in a child that presented clinically and radiologically as a tuberculous basal meningitis, and turned out to be a glioblastoma multiforme involving the thalamus, hypothalamus and brainstem, and spreading massively through the leptomeningeal and ventricular spaces. A 6-year-old girl presented with non-projectile vomiting and mild fever on October 1990. Over the ensuing 6 months she was found to have hydrocephalus and blurring of vision. She was treated for possible tuberculous meningitis without any improvement. Repeated CSF smears, cultures, cytology and brain CT did not provide any clue to a specific diagnosis. She remained stationary until January 23, 1992 when she elappsed into coma at home and died after supportive management for 7 days. Postmortem examination showed widespread gray white coating or nodules over the cerebellar and cerebral convexities as well as the brain base. Serial sections revealed that the main lesion was located in the thalamus, hypothalamus, and brainstem. Microscopically, it was a glioblastoma multiforme consisting predominantly of anaplastic spindle cells.