{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:18:14Z","timestamp":1788153494975,"version":"build-2803163510"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults, typically presenting as a single supratentorial lesion. Multifocal\/multicentric, and infratentorial variants are rare but clinically significant, often mimicking metastatic disease and limiting the feasibility of standard treatment. Their management remains challenging, and dedicated therapeutic guidelines are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We describe four uncommon GBM presentations, three multifocal supratentorial tumors and one cerebellar tumor, and integrate their clinical trajectories with a review of the literature to highlight diagnostic and therapeutic considerations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across cases, diagnosis required comprehensive neuroimaging and, in several instances, exclusion of an extracranial primary malignancy. Molecular profiles were consistent with\n                      <jats:italic>IDH<\/jats:italic>\n                      -wildtype GBM. Treatment feasibility varied substantially: one patient was unable to receive tumor-directed therapy because of poor performance status, one discontinued treatment after severe hematologic toxicity, one younger patient with preserved performance status initiated standard chemoradiotherapy, and the cerebellar GBM patient was not eligible for adjuvant therapy because of postoperative deterioration and posterior fossa involvement. Survival was short in three cases, ranging from approximately 50 days to 7.5 months after diagnosis, and was approximately one month in the cerebellar case.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Rare presentations of GBM, including multifocal and cerebellar disease, carry substantial diagnostic ambiguity, limited therapeutic options, and a markedly poor prognosis. Early multidisciplinary evaluation, optimized supportive care, and research focused on tailored treatment strategies are urgently needed to improve outcomes in these challenging GBM subtypes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1902596","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:27:56Z","timestamp":1788150476000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Rare presentations of glioblastoma: three multifocal and one cerebellar cases highlighting the value of shared clinical experience"],"prefix":"10.3389","volume":"16","author":[{"given":"N\u00eddia Maltez","family":"Cunha","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]},{"name":"Algarve Biomedical Center Research Institute (ABC-Ri)","place":["Faro, Portugal"]},{"name":"Algarve Biomedical Center (ABC)","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica Teot\u00f3nio","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Algarve Biomedical Center Research Institute (ABC-Ri)","place":["Faro, Portugal"]},{"name":"Algarve Biomedical Center (ABC)","place":["Faro, Portugal"]},{"name":"Faculdade de Medicina e Ci\u00eancias Biom\u00e9dicas (FMCB), Universidade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara Romero","family":"Sanchez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Drago","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filipa","family":"Sim\u00f5es","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bandarra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana","family":"Magalh\u00e3es","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaquim Pedro","family":"Correia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo","family":"Luz","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Unidade Local de Sa\u00fade do Algarve","place":["Faro, Portugal"]},{"name":"Faculdade de Medicina e Ci\u00eancias Biom\u00e9dicas (FMCB), Universidade do Algarve","place":["Faro, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab106","article-title":"The 2021 WHO classification of tumors of the central nervous system: a summary","volume":"23","author":"Louis","year":"2021","journal-title":"Neuro Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noaf194","article-title":"CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2018-2022","volume":"27","author":"Price","year":"2025","journal-title":"Neuro Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.01.086","article-title":"Patterns of management and outcomes of unifocal versus multifocal glioblastoma","volume":"74","author":"Haque","year":"2020","journal-title":"J Clin Neurosci"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-012-1030-1","article-title":"The incidence and significance of multiple lesions in glioblastoma","volume":"112","author":"Thomas","year":"2013","journal-title":"J Neuro-Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3171\/2012.7.JNS12147","article-title":"Prognosis of patients with multifocal glioblastoma: a case-control study","volume":"117","author":"Patil","year":"2012","journal-title":"J Neurosurg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-014-1515-1","article-title":"Comparison of clinical outcomes and genomic characteristics of single focus and multifocal glioblastoma","volume":"119","author":"Paulsson","year":"2014","journal-title":"J Neuro-Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14102412","article-title":"Epidemiology of glioblastoma multiforme-literature review","volume":"14","author":"Grochans","year":"2022","journal-title":"Cancers (Basel)"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043330","article-title":"Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma","volume":"352","author":"Stupp","year":"2005","journal-title":"N Engl J Med"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-020-00447-z","article-title":"EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood","volume":"18","author":"Weller","year":"2021","journal-title":"Nat Rev Clin Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hyac075","article-title":"Optimal managements of elderly patients with glioblastoma","volume":"52","author":"Arakawa","year":"2022","journal-title":"Jpn J Clin Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctro.2024.100761","article-title":"Management of glioblastoma in elderly patients: a review of the literature","volume":"46","author":"Mazarakis","year":"2024","journal-title":"Clin Trans Radiat Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2016.02.022","article-title":"Multifocal and multicentric glioblastoma: improved characterisation with FLAIR imaging and prognostic implications","volume":"31","author":"Lasocki","year":"2016","journal-title":"J Clin Neurosci"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-325334","article-title":"Advances in the management of glioblastoma","volume":"92","author":"Ma","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1177\/19714009231193162","article-title":"Multifocal and multicentric glioblastoma: imaging signature, molecular characterization, patterns of spread, and treatment","author":"Farhat","year":"2023","journal-title":"Neuroradiol J"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-024-05959-0","article-title":"Cerebellar glioblastoma in adults: a comparative single-center matched pair analysis and systematic review of the literature","volume":"150","author":"Lizunou","year":"2024","journal-title":"J Cancer Res Clin Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2020.10.049","article-title":"Treatment patterns and outcomes for cerebellar glioblastoma in the concomitant chemoradiation era: a National Cancer database study","volume":"82","author":"Zhang","year":"2020","journal-title":"J Clin Neurosci"},{"key":"B17","doi-asserted-by":"crossref","DOI":"10.15586\/codon.glioblastoma.2017.ch8","article-title":"Epidemiology and outcome of glioblastoma","volume-title":"Glioblastoma","author":"Tamimi","year":"2017"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol29050280","article-title":"Newly diagnosed multifocal GBM: a monocentric experience and literature review","volume":"29","author":"Baro","year":"2022","journal-title":"Curr Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1963.20.2.0122","article-title":"The problem of multicentric gliomas","volume":"20","author":"Batzdorf","year":"1963","journal-title":"J Neurosurg"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1186\/s12880-023-01183-3","article-title":"Differentiation of multiple brain metastases and glioblastoma with multiple foci using MRI criteria","volume":"24","author":"M\u00fcller","year":"2024","journal-title":"BMC Med Imaging"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1186\/s41016-020-00223-z","article-title":"Multifocal glioblastoma\u2014two case reports and literature review","volume":"7","author":"Zhang","year":"2021","journal-title":"Chin Neurosurg Jl"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.neurad.2015.10.006","article-title":"Radiological features of cerebellar glioblastoma","volume":"43","author":"Kikuchi","year":"2016","journal-title":"J Neuroradiol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.3171\/2012.7.JNS12147","article-title":"Prognosis of patients with multifocal glioblastoma: a case-control study","volume":"117","author":"Patil","year":"2012","journal-title":"J Neurosurg"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3390\/tomography7040045","article-title":"Is it worth considering multicentric high-grade glioma a surgical disease? Analysis of our clinical experience and literature review","volume":"7","author":"Guerrini","year":"2021","journal-title":"Tomography"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1902596\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:28:00Z","timestamp":1788150480000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1902596\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":24,"alternative-id":["10.3389\/fonc.2026.1902596"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1902596","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]},"article-number":"1902596"}}