Supplementary Material for: Intramedullary Glioblastoma as one of multiple radiation-induced neoplasms: Case Report

Background
Intramedullary glioblastoma is a rare entity comprising 1,4-9% of spinal gliomas. Spinal cord radiation-induced gliomas are unique, with only thirteen cases reported to date.
Case presentation
A 53-year-old female with a history of mediastinal Hodgkin lymphoma treated with chemotherapy and radiotherapy who subsequently developed thyroid cancer and breast cancer throughout her life, was admitted due to slowly progressing spastic tetraparesis. Cervical MRI revealed an intramedullary lesion at the C4-T1 level, enlarging the spinal cord, with a heterogenous contrast enhancement and a lesion within T1 vertebral body showing contrast enhancement. Whole body 18F-FDG-PET/CT revealed increased radionuclide uptake within the cervical spinal cord at the C2-C7 level and a focus of increased metabolic activity within the T1 vertebral body. The patient underwent a C4-T2 laminectomy with tumor debulking, and a biopsy of the T1 vertebral body was taken. Closure was performed with thecal sac expansion using a fascia lata graft, and laminoplasty was performed using the open-door technique. Postoperatively, the patient experienced progression of lower extremities and left arm paresis. The histomolecular results confirmed the diagnosis of Glioblastoma, IDH-wildtype (CNS WHO G4) in the cervical spinal cord lesion and breast cancer metastasis in the T1 vertebral body. No adjuvant therapy was administered due to neurological deficit progression. The patient died 6 months after surgery.
Conclusion
We report a case of an intramedullary glioblastoma in a patient with a history of radiation and multiple neoplasms located at the irradiation field borders. The full molecular analysis allowed for classification of the tumor as Glioblastoma, IDH-wildtype (CNS WHO G4) and screening for germinal mutations potentially predisposing to spontaneous neoplasm development.