{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:08:28Z","timestamp":1776096508121,"version":"3.50.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"14","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,4,6]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Tumor-to-tumor metastasis is a rare oncological phenomenon in which one neoplasm serves as the recipient for metastatic seeding from another primary tumor. Glioblastoma is an exceptionally uncommon recipient, and no prior reports have described this process occurring in the setting of atypical early imaging presentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>\n                      The authors present an unusual case of a 75-year-old man with hemiplegia and hemianesthesia with initial brain imaging demonstrating a solitary right basal ganglia diffusion-restricting, nonenhancing lesion initially diagnosed as a subacute ischemic stroke. Follow-up imaging triggered by progression of patient\u2019s 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 glioblastoma,\n                      <jats:italic>IDH<\/jats:italic>\n                      -wildtype (CNS WHO grade 4) and concurrent metastatic pulmonary adenocarcinoma. Despite whole-brain radiation therapy, the patient\u2019s condition rapidly deteriorated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights the importance of maintaining diagnostic suspicion for dual pathology in atypical intracranial lesions with progressive, otherwise unexplained symptoms. Furthermore, this case highlights the challenges in recognizing early glioblastoma presenting with nonenhancing, diffusion-restricting imaging features that may closely mimic subacute ischemic stroke. The integration of histopathology, immunochemistry, and molecular profiling is critical in recognizing this entity and carries significant implications for accurate diagnosis and treatment.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25992\">https:\/\/thejns.org\/doi\/10.3171\/CASE25992<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25992","type":"journal-article","created":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T10:04:37Z","timestamp":1775642677000},"source":"Crossref","is-referenced-by-count":0,"title":["Basal ganglia glioblastoma with lung adenocarcinoma tumor-to-tumor metastasis and atypical early imaging presentation: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Ramzi","family":"Badra","sequence":"first","affiliation":[{"name":"Edward Via College of Osteopathic Medicine, Blacksburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristine","family":"Ravina","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carilion Clinic, Roanoke"},{"name":"Virginia Tech Carilion School of Medicine, Roanoke"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony J.","family":"Emanuel","sequence":"additional","affiliation":[{"name":"Dominion Pathology Associates, Roanoke, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua A.","family":"Cuoco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carilion Clinic, Roanoke"},{"name":"Virginia Tech Carilion School of Medicine, Roanoke"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric A.","family":"Marvin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carilion Clinic, Roanoke"},{"name":"Virginia Tech Carilion School of Medicine, Roanoke"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cara M.","family":"Rogers","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carilion Clinic, Roanoke"},{"name":"Virginia Tech Carilion School of Medicine, Roanoke"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Cancer","first-page":"635","article-title":"Metastases of cancer to cancer","volume":"22","author":"Campbell","year":"1968","unstructured":"Campbell LVJrGilbert EChamberlain CRJrWatne AL.Metastases of cancer to cancer. Cancer. 1968;22(3):635-643. doi:10.1002\/1097-0142(196809)22:3<635::aid-cncr2820220320>3.0.co;2-o"},{"issue":"8","key":"bib2","series-title":"Int J Surg Pathol","first-page":"1520","article-title":"Glioblastoma with probable intratumoral adenocarcinoma metastasis: a rare report with review of literature","volume":"32","author":"Goyal","year":"2024","unstructured":"Goyal ARao SBhat DISantosh V.Glioblastoma with probable intratumoral adenocarcinoma metastasis: a rare report with review of literature. Int J Surg Pathol. 2024;32(8):1520-1524. doi:10.1177\/10668969241231979"},{"issue":"6","key":"bib3","series-title":"Neuropathology","first-page":"474","article-title":"Glioblastoma with tumor-to-tumor metastasis from lung adenocarcinoma","volume":"39","author":"Fioravanzo","year":"2019","unstructured":"Fioravanzo ASimbolo MGiampiccolo DGlioblastoma with tumor-to-tumor metastasis from lung adenocarcinoma. Neuropathology. 2019;39(6):474-478. doi:10.1111\/neup.12601"},{"issue":"2","key":"bib4","series-title":"Turk Neurosurg","first-page":"151","article-title":"Tumor-to-tumor metastasis of the central nervous system","volume":"24","author":"Erdogan","year":"2014","unstructured":"Erdogan HAydin MVTasdemiroglu E.Tumor-to-tumor metastasis of the central nervous system. Turk Neurosurg. 2014;24(2):151-162. doi:10.5137\/1019-5149.JTN.8317-13.1"},{"key":"bib5","series-title":"Arch Neurol","first-page":"559","article-title":"Carcinoma metastasis to malignant glioma; case report","volume":"3","author":"Posnikoff","year":"1960","unstructured":"Posnikoff JStratford J.Carcinoma metastasis to malignant glioma; case report. Arch Neurol. 1960;3:559-563. doi:10.1001\/archneur.1960.00450050079009"},{"issue":"4","key":"bib6","series-title":"Acta Neuropathol","first-page":"448","article-title":"Metastasis of renal carcinoma colliding with glioblastoma. 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International Agency for Research on Cancer; 2021."},{"issue":"9","key":"bib8","series-title":"Cureus","first-page":"e92895","article-title":"Computed tomography and magnetic resonance imaging findings in early glioblastoma (e-GBM): spotting the wolf in sheep\u2019s clothing","volume":"17","author":"Ajjikuttira","year":"2025","unstructured":"Ajjikuttira AALi SHaghighatpanah MSharma PJeffree RRoberts J.Computed tomography and magnetic resonance imaging findings in early glioblastoma (e-GBM): spotting the wolf in sheep\u2019s clothing. Cureus. 2025;17(9):e92895. doi:10.7759\/cureus.92895"},{"issue":"11","key":"bib9","series-title":"Radiol Med","first-page":"1468","article-title":"Early stage glioblastoma: retrospective multicentric analysis of clinical and radiological features","volume":"126","author":"Ceravolo","year":"2021","unstructured":"Ceravolo IBarchetti GBiraschi FEarly stage glioblastoma: retrospective multicentric analysis of clinical and radiological features. 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J Cereb Blood Flow Metab. 2016;36(9):1481-1507. doi:10.1177\/0271678X16655551"},{"issue":"2","key":"bib16","series-title":"Nat Med","first-page":"192","article-title":"Regulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke","volume":"15","author":"Liesz","year":"2009","unstructured":"Liesz ASuri-Payer EVeltkamp CRegulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke. Nat Med. 2009;15(2):192-199. doi:10.1038\/nm.1927"},{"key":"bib17","series-title":"Front Neurosci","first-page":"297","article-title":"Regeneration enhances metastasis: a novel role for neurovascular signaling in promoting melanoma brain metastasis","volume":"13","author":"Prakash","year":"2019","unstructured":"Prakash RIzraely SThareja NSRegeneration enhances metastasis: a novel role for neurovascular signaling in promoting melanoma brain metastasis. 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