Virginia Via Research Day Book 2026

Medical Student Research Case Reports

11 BASAL GANGLIA GLIOBLASTOMA WITH LUNG ADENOCARCINOMA TUMOR-TO-TUMOR METASTASIS IN THE SETTING OF ISCHEMIC STROKE: ILLUSTRATIVE CASE

Ramzi Badra, OMS-III; Kristine Ravina, MD; Anthony J. Emanuel, MD; Joshua A. Cuoco, DO; Eric A. Marvin, DO; Cara M. Rogers, DO Corresponding author: rbadra@vt.vcom.edu

VCOM-Virginia, Blacksburg, Virginia Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia Virginia Tech Carilion School of Medicine, Roanoke, Virginia Dominion Pathology Associates, Roanoke, Virginia Context: Tumor-to-tumor metastasis is a rare oncologic phenomenon in which one neoplasm serves as the recipient for metastatic seeding from another primary tumor. Among these, glioblastoma serving as a recipient for metastatic carcinoma is exceedingly uncommon. Preceding ischemic stroke can potentially facilitate this process via blood-brain barrier disruption and a creating a microenvironment permissive for tumor growth. Report of Case: We present an unusual case of a 75-year-old man with progressive hemiplegia found to have a right basal ganglia lesion with initial imaging features consistent with ischemic stroke. Follow-up imaging triggered by progression of patient’s weakness revealed rapid lesion enlargement and new contrast enhancement. Stereotactic biopsy demonstrated features of both, high grade glioma and metastatic pulmonary adenocarcinoma. Subsequent molecular profiling confirmed IDH-wildtype diffuse astrocytic glioma, WHO grade IV (glioblastoma) and

metastatic pulmonary adenocarcinoma. Despite whole brain radiation, the patient’s condition deteriorated, and he entered hospice care shortly after discharge. Comments: Among the reported cases, the combination of glioblastoma and metastatic carcinoma represents one of the least frequently encountered entities in neuro-oncology. Since the first documented case of carcinoma metastasizing into a malignant glioma in 1960, fewer than 20 cases have been reported in the literature, with only three of those being in glioblastoma patients. Notably, among these cases, only one involved pulmonary carcinoma as the metastatic donor, and there has never been a documented case of this phenomenon occurring in the setting of prior ischemic injury. It is plausible that this initial insult may have facilitated microenvironmental changes leading to malignant transformation and metastatic seeding. In this report, we discuss the potential pathophysiological mechanisms involving both the primary and metastatic brain malignancy and ischemic microenvironment that

may have contributed to one of the rarest occurrences in neuro-oncology. Methods: Literature review was conducted using search terms: “tumor-to-tumor metastasis”, “collision tumor”, “glioblastoma”, “ischemic stroke”, and “lung adenocarcinoma” using public-access resources such as PubMed and Google Scholar. Diagnosis: Patient was initially found to have imaging findings of subacute ischemic stroke with subsequent malignant transformation into IDH-wildtype diffuse astrocytic glioma, WHO grade IV and tumor-to tumor metastasis from pulmonary adenocarcinoma. Informed Consent:The necessary informed consent was obtained.

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48 Edward Via College of Osteopathic Medicine (VCOM)