Primary glioblastoma of the spinal cord is a rare and aggressive tumor, comprising less than 1.5% of spinal neoplasms. It typically affects young adult males and arises in the cervical or thoracic regions. We report an unusual case of intradural extramedullary spinal glioblastoma in a 62-year-old man with prior lymphoma in remission. The patient presented with a 7-month history of progressive lower limb weakness, numbness, and radiating pain. MRI revealed a contrast-enhancing mass at the T6–7 level, initially suspected as lymphoma. Surgical resection via total laminectomy was performed, and en-bloc tumor removal achieved. Histopathological analysis confirmed WHO grade IV glioblastoma, IDH-wildtype, without Histone H3 mutation. This case highlights an atypical radiologic and anatomical presentation, complicating preoperative diagnosis. Histopathologic and molecular studies were essential for confirmation. Postoperative treatment included adjuvant radiotherapy and temozolomide, though their efficacy remains uncertain in spinal glioblastoma due to limited evidence and spinal cord radiosensitivity. Early biopsy and a multimodal diagnostic approach are critical for managing rare spinal tumors presenting with nonspecific clinical and imaging features.

Spinal cord tumors are uncommon lesions and can lead to significant neurologic morbidity and mortality. The classification of spinal cord tumors is based on their location as intradural intramedullary, intradural extramedullary, and extradural. Ependymomas are more common among intradural intramedullary tumors, and can often be surgically resected, whereas, astrocytomas infiltrate the spinal cord and show unclear marginality between the tumor and spinal cord. Complete surgical resection is obtained rarely. Intradural extramedullary tumors include schwannomas, neurofibromas, and meningiomas. These types are relatively curable with surgical resection than intradural intramedullary tumors. Radiotherapy is applied for malignant variants and recurrent tumors, whereas chemotherapy is usually recommended for recurrent lesions which are not effective with surgery or radiotherapy. Preoperative neurological status, histologic grade of the tumor, and the extent of surgical resection result in different outcomes.