1
|
Hong B, Lalk M, Wiese B, Merten R, Heissler HE, Raab P, Hartmann C, Krauss JK. Primary and secondary gliosarcoma: differences in treatment and outcome. Br J Neurosurg 2024; 38:332-339. [PMID: 33538191 DOI: 10.1080/02688697.2021.1872773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There are only few studies comparing differences in the outcome of primary versus secondary gliosarcoma. This study aimed to review the outcome and survival of patients with primary or secondary gliosarcoma following surgical resection and adjuvant treatment. The data were also matched with data of patients with primary and secondary glioblastoma (GBM). PATIENTS AND METHODS Treatment histories of 10 patients with primary gliosarcoma and 10 patients with secondary gliosarcoma were analysed and compared. Additionally, data of 20 patients with primary and 20 patients with secondary GBM were analysed and compared. All patients underwent surgical resection of the tumour in our department. Follow-up data, progression-free survival (PFS), and median overall survival (mOS) were evaluated. RESULTS The median PFS in patients with primary gliosarcoma was significantly higher than in patients with secondary gliosarcoma (p = 0.037). The 6-month PFS rates were 80.0% in patients with primary and 30.0% in patients with secondary gliosarcoma. Upon recurrence, five patients with primary gliosarcoma and four patients with secondary gliosarcoma underwent repeat surgical resection. The mOS of patients with primary gliosarcoma was significantly higher than that of patients with secondary gliosarcoma (p = 0.031). The percentage of patients surviving at 1-year/2-year follow-up in primary gliosarcoma was 70%/20%, while it was only 10%/10% in secondary gliosarcoma. When PFS and mOS of primary gliosarcoma was compared to primary GBM, there were no statistically differences (p = 0.509; p = 0.435). The PFS and mOS of secondary gliosarcoma and secondary GBM were also comparable (p = 0.290 and p = 0.390). CONCLUSION Patients with primary gliosarcoma have a higher PFS and mOS compared to those with secondary gliosarcoma. In the case of tumour recurrence, patients with secondary gliosarcoma harbour an unfavourable prognosis with limited further options. The outcome of patients with primary or secondary gliosarcoma is comparable to that of patients with primary or secondary GBM.
Collapse
Affiliation(s)
- Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- Department of Neurosurgery, Brandenburg Medical School, Helios Medical Center, Bad Saarow, Germany
| | - Michael Lalk
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Bettina Wiese
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Roland Merten
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department for Neuropathology, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
2
|
Labak CM, Rabah NM, Kipke JP, Mahajan UV, Labak KB, Ali SA, Fowler N, Sloan AE. Multidisciplinary approaches to gliosarcoma: A case report and review of the literature. Clin Case Rep 2022; 10:e5985. [PMID: 36017117 PMCID: PMC9396286 DOI: 10.1002/ccr3.5985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
A 58‐year‐old right‐handed man presented to our tertiary care center with gliosarcoma (GS) infiltration through the dura, skull, and soft tissue. Patient had a previous history of right temporal GS, with four intracranial surgeries prior to presentation. A multidisciplinary approach was used to treat the lesion and perform reconstruction.
Collapse
Affiliation(s)
- Collin M. Labak
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Nicholas M. Rabah
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Jasmine P. Kipke
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Uma V. Mahajan
- Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | - S. Ahmed Ali
- Department of Otolaryngology University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
| | - Nicole Fowler
- Department of Otolaryngology University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
- Seidman Cancer Center and Case Comprehensive Cancer Center Cleveland Ohio USA
| | - Andrew E. Sloan
- Department of Neurosurgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
- Seidman Cancer Center and Case Comprehensive Cancer Center Cleveland Ohio USA
| |
Collapse
|
3
|
Zaki MM, Mashouf LA, Woodward E, Langat P, Gupta S, Dunn IF, Wen PY, Nahed BV, Bi WL. Genomic landscape of gliosarcoma: distinguishing features and targetable alterations. Sci Rep 2021; 11:18009. [PMID: 34504233 PMCID: PMC8429571 DOI: 10.1038/s41598-021-97454-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
Gliosarcoma is an aggressive brain tumor with histologic features of glioblastoma (GBM) and soft tissue sarcoma. Despite its poor prognosis, its rarity has precluded analysis of its underlying biology. We used a multi-center database to characterize the genomic landscape of gliosarcoma. Sequencing data was obtained from 35 gliosarcoma patients from Genomics Evidence Neoplasia Information Exchange (GENIE) 5.0, a database curated by the American Association of Cancer Research (AACR). We analyzed genomic alterations in gliosarcomas and compared them to GBM (n = 1,449) and soft tissue sarcoma (n = 1,042). 30 samples were included (37% female, median age 59 [IQR: 49–64]). Nineteen common genes were identified in gliosarcoma, defined as those altered in > 5% of samples, including TERT Promoter (92%), PTEN (66%), and TP53 (60%). Of the 19 common genes in gliosarcoma, 6 were also common in both GBM and soft tissue sarcoma, 4 in GBM alone, 0 in soft tissue sarcoma alone, and 9 were more distinct to gliosarcoma. Of these, BRAF harbored an OncoKB level 1 designation, indicating its status as a predictive biomarker of response to an FDA-approved drug in certain cancers. EGFR, CDKN2A, NF1, and PTEN harbored level 4 designations in solid tumors, indicating biological evidence of these biomarkers predicting a drug-response. Gliosarcoma contains molecular features that overlap GBM and soft tissue sarcoma, as well as its own distinct genomic signatures. This may play a role in disease classification and inclusion criteria for clinical trials. Gliosarcoma mutations with potential therapeutic indications include BRAF, EGFR, CDKN2A, NF1, and PTEN.
Collapse
Affiliation(s)
- Mark M Zaki
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA.,Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Leila A Mashouf
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Eleanor Woodward
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Pinky Langat
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Saksham Gupta
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Patrick Y Wen
- Center for NeuroOncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Brian V Nahed
- Center for NeuroOncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA.
| |
Collapse
|
4
|
Maurer CJ, Mader I, Joachimski F, Staszewski O, Märkl B, Urbach H, Roelz R. Do gliosarcomas have distinct imaging features on routine MRI? Neuroradiol J 2021; 34:501-508. [PMID: 33928823 PMCID: PMC8551440 DOI: 10.1177/19714009211012345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of this study was the development and external validation of a logistic regression model to differentiate gliosarcoma (GSC) and glioblastoma multiforme (GBM) on standard MR imaging. METHODS A univariate and multivariate analysis was carried out of a logistic regression model to discriminate patients histologically diagnosed with primary GSC and an age and sex-matched group of patients with primary GBM on presurgical MRI with external validation. RESULTS In total, 56 patients with GSC and 56 patients with GBM were included. Evidence of haemorrhage suggested the diagnosis of GSC, whereas cystic components and pial as well as ependymal invasion were more commonly observed in GBM patients. The logistic regression model yielded a mean area under the curve (AUC) of 0.919 on the training dataset and of 0.746 on the validation dataset. The accuracy in the validation dataset was 0.67 with a sensitivity of 0.85 and a specificity of 0.5. CONCLUSIONS Although some imaging criteria suggest the diagnosis of GSC or GBM, differentiation between these two tumour entities on standard MRI alone is not feasible.
Collapse
Affiliation(s)
- Christoph J Maurer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Germany
| | - Irina Mader
- Department of Neuroradiology, Medical Center, University of Freiburg, Germany.,Department of Radiology, Schön-Klinik, Germany
| | - Felix Joachimski
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Germany
| | - Ori Staszewski
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Germany
| | - Bruno Märkl
- Institute of Pathology, University Hospital Augsburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Germany
| | - Roland Roelz
- Department of Neurosurgery, Faculty of Medicine, University of Freiburg, Germany
| |
Collapse
|
5
|
Hsu BH, Lee WH, Yang ST, Han CT, Tseng YY. Spinal metastasis of glioblastoma multiforme before gliosarcomatous transformation: a case report. BMC Neurol 2020; 20:178. [PMID: 32393192 PMCID: PMC7216360 DOI: 10.1186/s12883-020-01768-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/06/2020] [Indexed: 11/21/2022] Open
Abstract
Background Glioblastoma multiforme (GBM) is one of the most aggressive malignant brain tumors. Intracranial GBM metastases to the spine are rarely detected clinically. Secondary gliosarcomas after treatment of primary GBM are rarely described. Case presentation Herein, we report the case of a 53-year-old woman who presented to our emergency room with progressive headache and weakness on the left side. Plain computed tomography and contrast magnetic resonance imaging of the brain revealed an approximately 6.8 cm × 4.5 cm right temporoparietooccipital intraaxial cystic tumor with surrounding diffuse perifocal edema that caused midline shift toward the left. Emergency craniotomy was performed to remove the tumor, and pathological examination revealed GBM. The patient received proton beam therapy, Gliadel implantation, and oral temozolomide chemotherapy as well as targeted therapy with bevacizumab. Approximately 15 months after diagnosis, she underwent surgical resection of the right temporal recurrent tumor and was newly diagnosed as having a metastatic spinal tumor. Pathologically, the right temporal and metastatic spinal tumors were gliosarcoma and GBM, respectively. Conclusions Concurrent spinal metastasis and gliosarcomatous transformation, which are two types of GBM complications, are rare. To our knowledge, this is the first report of a case of recurrent GBM with gliosarcoma after proton bean therapy.
Collapse
Affiliation(s)
- Bing-Hung Hsu
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan, R.O.C
| | - Wei-Hwa Lee
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Shun-Tai Yang
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan, R.O.C.,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Ta Han
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan, R.O.C
| | - Yuan-Yun Tseng
- Division of Neurosurgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 235, Taiwan, R.O.C.. .,Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
6
|
Fukuda A, Queiroz LDS, Reis F. Gliosarcomas: magnetic resonance imaging findings. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:112-120. [PMID: 32022137 DOI: 10.1590/0004-282x20190158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/01/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Central nervous system (CNS) gliosarcoma (GSM) is a rare primary neoplasm characterized by the presence of glial and sarcomatous components. OBJECTIVE In this report, we describe the clinical and neuroimaging aspects of three cases of GSM and correlate these aspects with pathological findings. We also provide a brief review of relevant literature. METHODS Three patients were evaluated with magnetic resonance imaging (MRI), and biopsies confirmed the diagnosis of primary GSM, without previous radiotherapy. RESULTS The analysis of conventional sequences (T1, T1 after contrast injection, T2, Fluid attenuation inversion recovery, SWI and DWI/ADC map) and advanced (proton 1H MR spectroscopy and perfusion) revealed an irregular, necrotic aspect of the lesion, peritumoral edema/infiltration and isointensity of the solid component on a T2-weighted image. These features were associated with irregular and peripheral contrast enhancement, lipid and lactate peaks, increased choline and creatine levels in proton spectroscopy, increased relative cerebral blood volume (rCBV) in perfusion, multifocality and drop metastasis in one of the cases. CONCLUSION These findings are discussed in relation to the general characteristics of GSM reported in the literature.
Collapse
Affiliation(s)
- Aya Fukuda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brazil
| | - Luciano de Souza Queiroz
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Anatomia Patológica, Campinas SP, Brazil
| | - Fabiano Reis
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brazil
| |
Collapse
|
7
|
Tunthanathip T, Tawaranurak N, Kanjanapradit K. Extraneural metastatic gliosarcoma: A case report and review of the literature. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
8
|
Frandsen S, Broholm H, Larsen VA, Grunnet K, Møller S, Poulsen HS, Michaelsen SR. Clinical Characteristics of Gliosarcoma and Outcomes From Standardized Treatment Relative to Conventional Glioblastoma. Front Oncol 2019; 9:1425. [PMID: 31921679 PMCID: PMC6928109 DOI: 10.3389/fonc.2019.01425] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Gliosarcoma (GS) is a rare histopathologic variant of glioblastoma (GBM) characterized by a biphasic growth pattern consisting of both glial and sarcomatous components. Reports regarding its relative prognosis compared to conventional GBM are conflicting and although GS is treated as conventional GBM, supporting evidence is lacking. The aim of this study was to characterize demographic trends, clinical outcomes and prognostic variables of GS patients receiving standardized therapy and compare these to conventional GBM. Methods: Six hundred and eighty GBM patients, treated with maximal safe resection followed by radiotherapy with concomitant and adjuvant temozolomide at a single institution, were retrospectively reevaluated by reviewing histopathological records and tumor tissue for identification of GS patients. Clinico-pathological- and tumor growth characteristics were obtained via assessment of medical records and imaging analysis. Kaplan-Meier survival estimates were compared with log-rank testing, while Cox-regression modeling was tested for prognostic factors in GS patients. Results: The cohort included 26 primary gliosarcoma (PGS) patients (3.8%) and 7 secondary gliosarcoma (SGS) patients (1.0%). Compared to conventional GBM tumors, PGS tumors were significantly more often MGMT-unmethylated (73.9%) and located in the temporal lobe (57.7%). GS tumors often presented dural contact, while extracranial metastasis was only found in 1 patient. No significant differences were found between PGS and conventional GBM in progression-free-survival (6.8 and 7.6 months, respectively, p = 0.105) and in overall survival (13.4 and 15.7 months, respectively, p = 0.201). Survival following recurrence was not significantly different between PGS, SGS, and GBM. Temporal tumor location and MGMT status were found associated with PGS survival (p = 0.036 and p = 0.022, respectively). Conclusion: Despite histopathological and location difference between GS and GBM tumors, the patients present similar survival outcome from standardized treatment. These findings support continued practice of radiation and temozolomide for GS patients.
Collapse
Affiliation(s)
- Simone Frandsen
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark
| | - Helle Broholm
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | - Kirsten Grunnet
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark
| | - Søren Møller
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Signe Regner Michaelsen
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark.,Biotech Research and Innovation Centre (BRIC), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
9
|
Álvarez P, Wessmann A, Pascual M, Comas O, Pi D, Pumarola M. Cerebral gliosarcoma with perivascular involvement in a cat. JFMS Open Rep 2019; 5:2055116919879783. [PMID: 31636916 PMCID: PMC6787989 DOI: 10.1177/2055116919879783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Case summary A 5-year-old neutered male domestic shorthair cat presented with an 18-month
history of facial tics, and progressive general ataxia, weakness, lethargy
and anorexia of 2 weeks’ duration. MRI of the brain showed a well-defined
heterogeneous hyperintense mass on T1-weighted and T2-weighted images, with
central hypointensity in the rostral commissure and septum pellucidum, and
perilesional hyperintensity in fluid-attenuated inversion recovery,
suggestive of perilesional oedema. Gross examination in a transverse section
of the brain at the level of the septum pellucidum revealed a 0.2 cm brown
soft mass. Histopathological examination identified a biphasic neoplastic
proliferation of mesenchymal and neuroepithelial cell populations. Fusiform
cells were predominately distributed in bundles showing a high degree of
anisocytosis and marked immune-positive reaction to vimentin
immunochemistry, confirming a sarcomatous origin. Additionally, high numbers
of astrocytic cells were identified by an intense immunopositive reaction to
glial fibrillary acidic protein and negative reaction to oligodendrocyte
transcription factor 2 immunochemistry. Vascular invasion of the neoplasia
into the wall of a medium branch of the rostral cerebral artery was present
(secondary Scherer structures). Based on these characteristics, the tumour
was defined as a gliosarcoma. Gliosarcoma is a recognised astrocytoma grade
IV anaplastic glial cell tumour with sarcomatous differentiation. Relevance and novel information To our knowledge, this is the first report describing a cerebral gliosarcoma
in a cat including clinical, MRI, macroscopic and histopathological features
and immunolabelling characteristics.
Collapse
Affiliation(s)
- Patricia Álvarez
- Neurology and Neurosurgery Service, Pride Veterinary Centre, Derby, UK
| | - Annette Wessmann
- Neurology and Neurosurgery Service, Pride Veterinary Centre, Derby, UK
| | | | - Oriol Comas
- BalmesVet ClínicaVeterinaria, Barcelona, Spain
| | - Dolors Pi
- Unit of Murine and Comparative Pathology, Department of Animal Medicine and Surgery, Veterinary Faculty, Autonomous University of Barcelona, Spain
| | - Martí Pumarola
- Unit of Murine and Comparative Pathology, Department of Animal Medicine and Surgery, Veterinary Faculty, Autonomous University of Barcelona, Spain
| |
Collapse
|
10
|
Chen B, Liu B, Wu C, Wang Z. Prognostic factors among single primary gliosarcoma cases: A study using Surveillance, Epidemiology, and End Results data from 1973-2013. Cancer Med 2019; 8:6233-6242. [PMID: 31464103 PMCID: PMC6797573 DOI: 10.1002/cam4.2503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/30/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background Prognostic factors for single primary gliosarcoma (PGS) remain unknown. Objective The purpose of our study was to examine patient, tumor, and treatment characteristics as potential predictors of survival using Surveillance, Epidemiology, and End Results (SEER) program data (1973‐2013). Methods The patients of single PGS were selected based on the exclusion criteria from SEER. Kaplan‐Meier survival analysis, log‐rank test and Cox proportional hazards models were used to analyze all the data. Results Single PGS has an apparent popularity for the temporal lobe (35.2%, hazard ratio [HR] = 0.440, 95%CI = 0.251‐0.770) and frontal lobe (20.9%, HR = 0.408, 95%CI = 0.231‐0.720) which could achieve a better survival rate than cerebrum (P = .034). The mean age at diagnosis was 60.07 ± 14.161. The overall 6‐month, 1‐year, 2‐year, and 5‐year survival was 55.40%, 29.58%, 10.01%, and 2.73%. Age at diagnosis was proved to be a significant predictor of overall survival (OS) (P < .001). There is no significant difference in race, marital status, or grade. Patients' tumor size which is located in 41‐60 mm (P = .047, HR = 1.468, 95%CI = 1.004‐2.147) and >60 mm (P= .003, HR = 1.899, 95%CI = 1.244‐2.901) showed a higher risk of death. Surgery played a critical role in OS (P < .001). Radiation after surgery was another predictor of OS of PGS (P < .001). Among all the radiation methods, combination of beam with implants or isotopes (P = .000, HR = 0.491, 95%CI = 0.412‐0.585) or radiation NOS (P = .027, HR = 0.362, 95%CI = 0.148‐0.889) were more beneficial to patients. Conclusion This study indicated that single PGS has a poor prognosis. Prognosis of single PGS would become poorer along with patients' age and tumor size (>40 mm). Surgery intervention and radiation therapy were beneficial factors.
Collapse
Affiliation(s)
- Bin Chen
- Department of Neurosurgery, Peking University Third Hospital, Beijing, People's Republic of China
| | - Bin Liu
- Department of Neurosurgery, Peking University Third Hospital, Beijing, People's Republic of China
| | - Chao Wu
- Department of Neurosurgery, Peking University Third Hospital, Beijing, People's Republic of China
| | - Zhenyu Wang
- Department of Neurosurgery, Peking University Third Hospital, Beijing, People's Republic of China
| |
Collapse
|
11
|
Clinical characteristics and disease-specific prognostic nomogram for primary gliosarcoma: a SEER population-based analysis. Sci Rep 2019; 9:10744. [PMID: 31341246 PMCID: PMC6656887 DOI: 10.1038/s41598-019-47211-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
Because the study population with gliosarcoma (GSM) is limited, the understanding of this disease is insufficient. In this study, the authors aimed to determine the clinical characteristics and independent prognostic factors influencing the prognosis of GSM patients and to develop a nomogram to predict the prognosis of GSM patients after craniotomy. A total of 498 patients diagnosed with primary GSM between 2004 and 2015 were extracted from the 18 Registries Research Data of the Surveillance, Epidemiology, and End Results (SEER) database. The median disease-specific survival (DSS) was 12.0 months, and the postoperative 0.5-, 1-, and 3-year DSS rates were 71.4%, 46.4% and 9.8%, respectively. We applied both the Cox proportional hazards model and the decision tree model to determine the prognostic factors of primary GSM. The Cox proportional hazards model demonstrated that age at presentation, tumour size, metastasis state and adjuvant chemotherapy (CT) were independent prognostic factors for DSS. The decision tree model suggested that age <71 years and adjuvant CT were associated with a better prognosis for GSM patients. The nomogram generated via the Cox proportional hazards model was developed by applying the rms package in R version 3.5.0. The C-index of internal validation for DSS prediction was 0.67 (95% confidence interval (CI), 0.63 to 0.70). The calibration curve at one year suggested that there was good consistency between the predicted DSS and the actual DSS probability. This study was the first to develop a disease-specific nomogram for predicting the prognosis of primary GSM patients after craniotomy, which can help clinicians immediately and accurately predict patient prognosis and conduct further treatment.
Collapse
|
12
|
Langlois AM, Alarfaj AK, Sagga A, Findlay JM, Das S. Gliosarcoma in a Young Filipino Woman: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:914-919. [PMID: 31243260 PMCID: PMC6613492 DOI: 10.12659/ajcr.916020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Female, 28 Final Diagnosis: Gliosarcoma Symptoms: Foot drop Medication: — Clinical Procedure: — Specialty: Neurosurgery
Collapse
Affiliation(s)
- Anne-Marie Langlois
- Department of Medicine, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Abdullah K Alarfaj
- Division of Neurosurgery, University of Alberta, Walter Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - Aziz Sagga
- Division of Neurosurgery, University of Alberta, Walter Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - J Max Findlay
- Division of Neurosurgery, University of Alberta, Walter Mackenzie Health Sciences Center, Edmonton, Alberta, Canada
| | - Sumit Das
- Division of Neuropathology, University of Alberta, Walter Mackenzie Health Sciences Center, Edmonton, Alberta, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
13
|
Saadeh F, El Iskandarani S, Najjar M, Assi HI. Prognosis and management of gliosarcoma patients: A review of literature. Clin Neurol Neurosurg 2019; 182:98-103. [PMID: 31112812 DOI: 10.1016/j.clineuro.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
Gliosarcoma (GSM) is a variant of glioblastoma (GBM), the most common primary malignant brain tumor that occurs in adults. GSM is characterized by its biphasic components: the gliomatous and sarcomatous components and categorized into primary and secondary GSM. Intrinsic to the brain parenchyma, GSM is usually managed by gross total resection, and radiotherapy with/without chemotherapy. While the benefits of treatment remain unclear, cases have always been managed similar to GBM cases yielding different treatment outcomes between the two groups. The scarcity of research done on GSM suggests that further investigation is needed. Genetic studies on tumor samples and an in-depth examination of tumor subtypes and categories could result in identification of certain targetable alterations. The objective of this review is to summarize the available findings on characteristics, prognosis and management of GSM patients.
Collapse
Affiliation(s)
- Fadi Saadeh
- American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | | | - Marwan Najjar
- American University of Beirut Medical Center, Department of Surgery, Beirut, Lebanon
| | - Hazem I Assi
- American University of Beirut Medical Center, Department of Internal Medicine, Hematology and Oncology, Naef K. Basile Cancer Institute, Beirut, Lebanon.
| |
Collapse
|
14
|
Peckham ME, Osborn AG, Palmer CA, Tsai A, Salzman KL. Gliosarcoma: Neuroimaging and Immunohistochemical Findings. J Neuroimaging 2018; 29:126-132. [DOI: 10.1111/jon.12565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Miriam E. Peckham
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Anne G. Osborn
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Cheryl A. Palmer
- Department of Pathology; University of Utah Health Sciences Center; Salt Lake City UT
| | - Amy Tsai
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Karen L. Salzman
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| |
Collapse
|
15
|
Di Norcia V, Piccirilli M, Giangaspero F, Salvati M. Gliosarcomas in the Elderly: Analysis of 7 Cases and Clinico-Pathological Remarks. TUMORI JOURNAL 2018; 94:493-6. [DOI: 10.1177/030089160809400409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background Gliosarcomas are rare malignant primary brain tumors that usually affect the fifth or sixth decades of life. The purpose of this study was to describe our experience with such lesions in elderly patients and to establish their prognosis factors. Methods Between 1993 and 2001, 7 patients over 60 years of age were treated at our institute for cerebral gliosarcomas. All patients underwent surgery for total or at least sub-total removal of a neoplastic mass. Results Owing to poor clinical conditions (Karnofsky performance score = 40), one patient was not treated postoperatively. Remaining patients were treated with whole-brain radiotherapy, whereas concomitant chemotherapy (temozolomide) was administrated only to 4 patients. Histological examination showed the prevalence of sarcomatous aspects in 3 patients; the gliomatous aspect prevailed in 4 patients. Conclusions Sarcomatous aspects and multimodality treatment (surgery, radiotherapy and chemotherapy) were associated with a better prognosis and showed in these elderly patients a trend similar to that of young people.
Collapse
Affiliation(s)
- Valerio Di Norcia
- Department of Neurosurgical Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | - Manolo Piccirilli
- Department of Neurosurgical Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | | | | |
Collapse
|
16
|
Sampaio L, Linhares P, Fonseca J. Detailed magnetic resonance imaging features of a case series of primary gliosarcoma. Neuroradiol J 2017. [PMID: 28644110 DOI: 10.1177/1971400917715879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective We aimed to characterise the magnetic resonance imaging (MRI) features of a case series of primary gliosarcoma, with the inclusion of diffusion-weighted imaging and perfusion imaging with dynamic susceptibility contrast MRI. Materials and methods We conducted a retrospective study of cases of primary gliosarcoma from the Pathology Department database from January 2006 to December 2014. Clinical and demographic data were obtained. Two neuroradiologists, blinded to diagnosis, assessed tumour location, signal intensity in T1 and T2-weighted images, pattern of enhancement, diffusion-weighted imaging and dynamic susceptibility contrast MRI studies on preoperative MRI. Results Seventeen patients with primary gliosarcomas had preoperative MRI study: seven men and 10 women, with a mean age of 59 years (range 27-74). All lesions were well demarcated, supratentorial and solitary (frontal n = 5, temporal n = 4, parietal n = 3); 13 tumours abutted the dural surface (8/13 with dural enhancement); T1 and T2-weighted imaging patterns were heterogeneous and the majority of lesions (12/17) showed a rim-like enhancement pattern with focal nodularities/irregular thickness. Restricted diffusion (mean apparent diffusion coefficient values 0.64 × 10-3 mm2/s) in the more solid/thick components was present in eight out of 11 patients with diffusion-weighted imaging study. Dynamic susceptibility contrast MRI study ( n = 8) consistently showed hyperperfusion in non-necrotic/cystic components on relative cerebral volume maps. Conclusions The main distinguishing features of primary gliosarcoma are supratentorial and peripheral location, well-defined boundaries and a rim-like pattern of enhancement with an irregular thick wall. Diffusion-weighted imaging and relative cerebral volume map analysis paralleled primary gliosarcoma with high-grade gliomas, thus proving helpful in differential diagnosis.
Collapse
Affiliation(s)
- Luísa Sampaio
- 1 Neuroradiology Department, Centro Hospitalar de São João, Portugal
| | - Paulo Linhares
- 2 Neurosurgery Department, Centro Hospitalar de São João, Portugal.,3 Faculty of Medicine, Porto University, Portugal
| | - José Fonseca
- 1 Neuroradiology Department, Centro Hospitalar de São João, Portugal
| |
Collapse
|
17
|
Jain A, Correia J, Schweder P, McMahon A, Merola J, Aspoas R. Analysis of Outcomes of Multidisciplinary Management of Gliosarcoma: A Single-Center Study, 2000-2013. World Neurosurg 2017. [PMID: 28642179 DOI: 10.1016/j.wneu.2017.06.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gliosarcoma is a rare tumor of the central nervous system with a reported incidence of ∼2%-8% of all gliomas. We reviewed the outcomes of patients treated at our institution over a 14-year period from 2000 to 2013 to characterize overall survival (OS) and progression-free survival as well as to elucidate the additive effect of chemoradiotherapy. METHODS From January 1, 2000 to December 31, 2013, we retrospectively reviewed the clinical notes of all patients treated at our institution with a histopathologic diagnosis of gliosarcoma. This review yielded 21 patients whose clinicoradiologic data were analyzed with respect to age, sex, ethnicity, preoperative/postoperative Glasgow Coma Scale and Karnofsky Performance Scale, location, extent of resection, methylguanine DNA methyl transferase methylation status, and administration of adjuvant therapy. RESULTS The median age was 58 years (range, 40-80 years) with a male preponderance (1.6:1). Tumor location was mainly temporal (n = 6) but also parietal (n = 5), frontal (n = 4), multilobar (n = 4), and cerebellar (n = 1). Surgical resection was deemed to be total in 15 patients and subtotal in 6 patients. Methylguanine DNA methyl transferase methylation status was available for only 5 patients, with a methylation rate of 60% (3/5) and no impact on survival. Nine patients received both radiotherapy and chemotherapy (OS, 7.9 months), 7 received radiotherapy only (OS, 5.7 months), and 5 patients received no adjuvant therapy (OS, 1.4 months). The overall median survival was 5.7 months (range, 1-21.5 months) and median progression-free survival was 5 months (range, 1.4-12.4 months). CONCLUSIONS Despite an overall poor prognosis, a multimodality approach aiming for complete resection followed by radiotherapy and chemotherapy appears to be associated with better outcomes.
Collapse
Affiliation(s)
- Abhinav Jain
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Jason Correia
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Patrick Schweder
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Adele McMahon
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Joseph Merola
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - Robert Aspoas
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand.
| |
Collapse
|
18
|
Kakkar N, Kaur J, Singh GK, Singh P, Siraj F, Gupta A. Gliosarcoma in Young Adults: A Rare Variant of Glioblastoma. World J Oncol 2017; 8:53-57. [PMID: 29147435 PMCID: PMC5649997 DOI: 10.14740/wjon998w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2017] [Indexed: 11/17/2022] Open
Abstract
Gliosarcoma is a rare central nervous system (CNS) malignancy. It is characterized by classical biphasic histological pattern with both glial and sarcomatous components, often seen in fifth and sixth decade of life. They are generally located in the supratentorial region. Due to its rarity, exact treatment recommendations are not available in literature. Since it is considered as a variant of glioblastoma multiforme (GBM), it is treated with surgery followed by adjuvant radiotherapy and temozolomide-based chemotherapy. We present a series of four cases of this rare malignancy that were treated at our institute.
Collapse
Affiliation(s)
- Neha Kakkar
- Department of Radiotherapy, VMMC & Safdarjung Hospital, New Delhi 110029, India
| | - Jaspreet Kaur
- Department of Radiotherapy, VMMC & Safdarjung Hospital, New Delhi 110029, India
| | - Gunjesh Kumar Singh
- Department of Radiotherapy, VMMC & Safdarjung Hospital, New Delhi 110029, India
| | - Pragya Singh
- Department of Pathology, VMMC & Safdarjung Hospital, New Delhi 110029, India
| | - Fouzia Siraj
- National Institute of Pathology, New Delhi 110029, India
| | - Ajay Gupta
- Department of Radiotherapy, VMMC & Safdarjung Hospital, New Delhi 110029, India
| |
Collapse
|
19
|
Castelli J, Feuvret L, Haoming QC, Biau J, Jouglar E, Berger A, Truc G, Gutierrez FL, Morandi X, Le Reste PJ, Thillays F, Loussouarn D, Nouhaud E, Crehange G, Antoni D, Vauleon E, de Crevoisier R, Noel G. Prognostic and therapeutic factors of gliosarcoma from a multi-institutional series. J Neurooncol 2016; 129:85-92. [DOI: 10.1007/s11060-016-2142-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
|
20
|
Clinical outcome of gliosarcoma compared with glioblastoma multiforme: a clinical study in Chinese patients. J Neurooncol 2016; 127:355-62. [DOI: 10.1007/s11060-015-2046-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/25/2015] [Indexed: 11/25/2022]
|
21
|
Mallick S, Gandhi AK, Sharma DN, Gupta S, Haresh KP, Rath GK, Julka PK. Pediatric gliosarcoma treated with adjuvant radiotherapy and temozolomide. Childs Nerv Syst 2015; 31:2341-4. [PMID: 26438548 DOI: 10.1007/s00381-015-2919-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 09/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Primary pediatric gliosarcoma (pPGS) is an extremely rare entity with only 25 cases reported in the English literature. The value of concurrent and adjuvant temozolomide is not known in this group of patient. METHODS Five patients of pPGS treated from 2006 to 2011 were included in this retrospective analysis. All patients underwent maximal safe surgical resection. Adjuvant therapy included conformal radiation 60 Gy in 30 fractions (2 Gy daily for 5 days in a week) with concurrent temozolomide 75 mg/m(2) daily followed by six cycles of maintenance temozolomide 150-200 mg/m(2) (day 1 to day 5) every 4 weeks. We combined the survival data of 25 patients (already published) and five of our patients and analyzed them in terms of progression free survival (PFS) and overall survival (OS) using Kaplan-Meier method. RESULTS Male to female ratio was 1:4 and median age was 12 years (range, 7-19 years). All but one patient underwent gross total resection and four patients completed adjuvant radiotherapy as well as concurrent and adjuvant temozolomide. At a median follow up of 22.6 months (range, 0 to 45.3 months), two patients were dead and two were alive without disease while one was lost to follow up. For the pooled data, estimated median PFS and OS of all 30 patients reported in literature were 12 and 43 months, respectively. Two years PFS and OS rate for all patients was 44.2 and 62.9%, respectively. CONCLUSION Adjuvant radiotherapy and temozolomide is well tolerated and show an encouraging survival in pPGS.
Collapse
Affiliation(s)
- Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajeet Kumar Gandhi
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Kunhi P Haresh
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Kishor Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Julka
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
22
|
Primary Cerebellar Gliosarcoma with Extracranial Metastases: An Orphan Differential Diagnosis. World Neurosurg 2015; 84:2076.e13-7. [PMID: 26239018 DOI: 10.1016/j.wneu.2015.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gliosarcomas are rare, malignant primary brain tumors, most commonly located in the temporal lobe, that contain both glial and mesenchymal elements. Gliosarcomas located within the cerebellum are exceedingly rare. The previously unreported finding of a cerebellar gliosarcoma concurrently with an extracranial metastasis to the lungs is discussed here. CASE DESCRIPTION A 57-year-old man presented with a 3-month history of chest pain, weight loss, headaches, and vomiting. Physical examination revealed a left cerebellar dysfunction, and the radiological work-up revealed a 6 × 6-cm right apical pulmonary tumor and a 4 × 3.5 × 3.8-cm peripherally enhancing left cerebellar mass. On the basis of a smoking history in the setting of a lung lesion and cerebellar mass, the presumptive diagnosis was primary lung cancer with metastasis to the cerebellum. Gross total resection of a firm pseudo-encapsulated cerebellar mass was performed. The microscopic features and the immunohistochemical profile confirmed the diagnosis of Gliosarcoma. The thoracic lesion was removed subsequently, and pathology confirmed it as an extracranial metastasis from the cerebellar gliosarcoma. Adjuvant radiation and chemotherapy were then administered. No clinical or radiographic evidence of recurrence was observed during one year of follow-up monitoring. CONCLUSIONS To the best of our knowledge, a primary infratentorial gliosarcoma with extracranial metastases has not been previously described.
Collapse
|
23
|
Singh G, Das KK, Sharma P, Guruprasad B, Jaiswal S, Mehrotra A, Srivastava AK, Sahu RN, Jaiswal AK, Behari S. Cerebral gliosarcoma: Analysis of 16 patients and review of literature. Asian J Neurosurg 2015; 10:195-202. [PMID: 26396606 PMCID: PMC4553731 DOI: 10.4103/1793-5482.161173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Gliosarcoma (GS), a subtype of glioblastoma (GBM), is a rare primary neoplasm of the central nervous system. Certain features like temporal lobe affinity, tendency for extraneural metastasis and poorer outcome compared to GBM indicate that GS may indeed be a separate clinicopathologic entity. This led us to revisit this entity in our settings. MATERIALS AND METHODS Between 2009 and 2014, 16 cases of histologically proven GSs (14 primary, two secondary) were treated. Patient data were retrieved retrospectively. Statistical analysis was performed with? Statistical Package for Social Sciences, version 17.0. (Chicago, Illinois, USA). Survival was analyzed by Kaplan-Meier method. RESULTS GS predominantly affected males in their fifth decade of life. Raised intracranial pressure was the most common mode of clinical presentation. Temporal lobe was the most commonly affected part of the brain and majority of primary and all of secondary GBM were located peripherally. In 7 (43.8%) patients, tumor was radiologically well-demarcated and enhanced strongly and homogenously on contrast as compared to 9 (56.2%) patients where the tumor was ill-defined and showed heterogenous patchy or ring enhancement. Extent of excision was total in seven patients (43.8%), near total in 4 (25%) and subtotal in five patients (31.2%). Median survival was 6 months. Patients with well-demarcated, enhancing mass on imaging intraoperatively had firm tumors with a good plane of cleavage and had a better survival (8 months) compared to those in whom the tumor radiologically and intraoperatively mimicked GBM (2 months). CONCLUSION GS is associated with poor survival (median survival 6 months). Radiological and intraoperative findings help categorize these tumors into GBM like GS and meningioma like GS. While the former histologically mimics GBM and has very poor survival (2 months), GS with meningioma like feature tends to have better survival (8 months).
Collapse
Affiliation(s)
- Gajendra Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Kuntal K. Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Pradeep Sharma
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - B. Guruprasad
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Arun K. Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Rabi N. Sahu
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Awadhesh K. Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India
| |
Collapse
|
24
|
Abstract
Gliosarcoma (GS) is a malignant, uncommon variant of high-grade glioma comprised of infiltrative glial and atypical sarcomatous cells, identified in adult and pediatric populations. GS has been subcategorized into primary (de novo) and secondary tumors, with the latter typically arising in the setting of prior glioblastoma. Due to its rarity, the pathogenesis, epidemiology and optimal therapy of GS have been based on small retrospective cohort studies, with treatment presently utilizing regimens established for other high-grade gliomas, including combination of resection, radiotherapy and temozolomide-based chemotherapy. As more information is gathered about GS molecular profiles, novel treatment strategies may be developed to improve outcomes of GS patients. Here we summarize results of GS management with focus on the temozolomide era.
Collapse
Affiliation(s)
- Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 0097, Houston, TX 77030, USA
| | | |
Collapse
|
25
|
Martin J, Devadoss P, Kannan K, Kumar Sundarraj S. Malignant pediatric gliosarcoma defies general survival data. Case Rep Med 2014; 2014:175679. [PMID: 25580128 PMCID: PMC4281457 DOI: 10.1155/2014/175679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/13/2014] [Accepted: 09/09/2014] [Indexed: 12/13/2022] Open
Abstract
Gliosarcoma, a variant of glioblastoma multiforme, is a dimorphic tumor known for its intra-axial occurrence and poor survival of less than a year. Here is an 11-year-old boy with gliosarcoma. He had a near total excision and postoperative chemoradiotherapy. He has lived through the disease for over 34 months with a residual disease.This case report is to report an unusual long survival of gliosarcoma in a teenager (Ravisankar et al., 2012).
Collapse
Affiliation(s)
- Jovita Martin
- Department of Medical Oncology, Madras Medical College, Chennai, India
| | | | | | | |
Collapse
|
26
|
Linhares P, Martinho O, Carvalho B, Castro L, Lopes JM, Vaz R, Reis RM. Analysis of a synchronous gliosarcoma and meningioma with long survival: A case report and review of the literature. Surg Neurol Int 2014; 4:151. [PMID: 24381794 PMCID: PMC3872647 DOI: 10.4103/2152-7806.122229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/03/2013] [Indexed: 12/15/2022] Open
Abstract
Background: The simultaneous occurrence of multiple intracranial neoplasms has been reported, especially in genetic familial syndromes and after cranial irradiation. In the absence of these etiologic factors, some reports showed simultaneous occurrence of glioblastoma and meningioma but the association between gliosarcoma and meningioma is unknown. Case Description: We report a case of a 51-year-old woman with synchronous gliosarcoma and meningioma in whom extensive immunohistochemical characterization and molecular profile was performed. The gliosarcoma recurred 21 months after the first resection, reaching 3 years of overall survival. A molecular characterization of all three lesions was performed. None of the lesions showed the presence of mutations in TP53 and BRAF genes. MGMT analysis showed the presence of loss of expression associated with promoter hypermethylation in both gliosarcoma lesions. EGFR overexpression and gene amplification was found only in the recurrent gliosarcoma. Conclusion: The immunohistochemistry and molecular data of this unique case, suggest the distinct clonal origin of meningioma and gliosarcoma lesions, and the association of MGMT methylation with the presumable favorable prognosis observed.
Collapse
Affiliation(s)
- Paulo Linhares
- Department of Neurosurgery, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal
| | - Olga Martinho
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal ; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bruno Carvalho
- Department of Neurosurgery, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal
| | - Lígia Castro
- Department of Pathology, Hospital S. João, Porto, Portugal
| | - José Manuel Lopes
- Department of Pathology, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal ; Medical Faculty of Porto University, IPATIMUP, Porto, Portugal
| | - Rui Vaz
- Department of Neurosurgery, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal
| | - Rui Manuel Reis
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal ; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, S. Paulo, Brazil ; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
27
|
Walker GV, Gilbert MR, Prabhu SS, Brown PD, McAleer MF. Temozolomide use in adult patients with gliosarcoma: an evolving clinical practice. J Neurooncol 2012; 112:83-9. [DOI: 10.1007/s11060-012-1029-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 12/09/2012] [Indexed: 11/24/2022]
|
28
|
Andaloussi-Saghir K, Oukabli M, El Marjany M, Sifat H, Hadadi K, Mansouri H. Secondary gliosarcoma after the treatment of primary glioblastoma multiforme. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:527-30. [PMID: 22361502 PMCID: PMC3271412 DOI: 10.4297/najms.2011.3527] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Context: Gliosarcoma is a rare variant of glioblastoma multiforme containing distinct gliomatous and sarcomatous components. Gliosarcoma comprise 1.8–8% of glioblastoma multiforme and are clinically similar to them, affecting adults in the fourth and sixth decades of life, with a higher proportion found in males. The survival for patients with Gliosarcoma is equally poor as for those with glioblastoma multiforme, and there is a greater propensity for extracranial metastasis in Gliosarcoma. Clinical treatment-related experience reported in the literature is limited, and Gliosarcoma are currently treated in a similar fashion to glioblastoma multiforme, with modalities including tumor resection, postoperative radiation therapy, and chemotherapy. Gliosarcoma can arise secondarily, after conventional adjuvant treatment of high-grade glioma. The current literature on the occurrence of secondary gliosarcoma after glioblastoma multiforme is limited, with only 54 reported cases. Case Report: The authors present a 48-year-old Caucasian male who had previously received postoperative combined radiation and temozolomide chemotherapy for glioblastoma multiforme. After a free disease period of 9 months the disease recurs as Gliosarcoma. The patient underwent a Total surgical excision and received chemotherapy with a basis of bevacizumab and irinotecan. The patient died from tumor progression 5 months after gliosarcoma diagnosis. Conclusion: The poor survival of patients with secondary gliosarcoma who had previously received combined radiation and temozolomide chemotherapy for glioblastoma multiforme may reflect a unique molecular profile of glioblastoma multiforme that eventually recurs as secondary gliosarcoma. We have to keep in mind the possibility of gliosarcomatous change in the recurrence of malignant glioma. Awareness of this pathological entity will allow more rapid diagnosis and treatment.
Collapse
|
29
|
Swaidan MY, Hussaini M, Sultan I, Mansour A. Radiological findings in gliosarcoma. A single institution experience. Neuroradiol J 2012; 25:173-80. [PMID: 24028910 DOI: 10.1177/197140091202500203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 02/26/2012] [Indexed: 11/15/2022] Open
Abstract
Gliosarcomas are rare tumors with a poor prognosis composed of intermingled malignant glial and sarcoma elements with an estimated incidence of 1.8-8.0% of all malignant astrocytic neoplasms. We aimed to review the imaging findings in eight patients with gliosarcoma who were treated in our center between 2002 and 2010. The diagnosis was confirmed by morphological and immunohistochemical stains. This study, to the best of our knowledge, is the largest describing the imaging manifestations of this tumor. Although our study revealed no unique radiological features for gliosarcoma, it is important to note that they all demonstrated either dural or ependymal involvement or both. Calcification, hemorrhage or cystic components are described with a tendency for a ring enhancement pattern. Interestingly pre-existing benign looking lesions and associated remotely located small meningiomas are also described.
Collapse
|
30
|
Tahri R, Boulahroud O, Setti K, Oukabli M, El Ochi MR, Akhaddar A, Boucetta M, Albouzidi A. [Secondary gliosarcoma: case report]. Ann Pathol 2012; 32:147-50. [PMID: 22520611 DOI: 10.1016/j.annpat.2012.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 05/09/2011] [Accepted: 01/23/2012] [Indexed: 11/29/2022]
Abstract
Gliosarcoma is a rare tumor of the central nervous system, consisting of gliomatous and sarcomatous elements. The glioblastoma can undergo a change in phenotype, transforming into a gliosarcoma, especially when the tumor has been treated with radiotherapy. Features unique to gliosarcoma compared to glioblastoma include their potential to appear similar to a meningioma at macroscopy, repeated reports of metastases and infrequency of EGFR mutations. We present a case of secondary gliosarcoma to emphasize on the specificities, essentially diagnostical of this rare entity.
Collapse
Affiliation(s)
- Rajae Tahri
- Service d'anatomie pathologique, hôpital militaire d'instruction Mohammed V de Rabat, Rabat, Maroc.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Singh G, Mallick S, Sharma V, Joshi N, Purkait S, Jha P, Sharma MC, Suri V, Julka PK, Mahapatra AK, Singh M, Kale SS, Sarkar C. A study of clinico-pathological parameters and O6- methylguanine DNA methyltransferase (MGMT) promoter methylation status in the prognostication of gliosarcoma. Neuropathology 2012; 32:534-42. [DOI: 10.1111/j.1440-1789.2012.01297.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Fronza R, Tramonti M, Atchley WR, Nardini C. Brain cancer prognosis: independent validation of a clinical bioinformatics approach. J Clin Bioinforma 2012; 2:2. [PMID: 22297051 PMCID: PMC3296594 DOI: 10.1186/2043-9113-2-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 02/01/2012] [Indexed: 11/12/2022] Open
Abstract
Translational and evidence based medicine can take advantage of biotechnology advances that offer a fast growing variety of high-throughput data for screening molecular activities of genomic, transcriptional, post-transcriptional and translational observations. The clinical information hidden in these data can be clarified with clinical bioinformatics approaches. We have recently proposed a method to analyze different layers of high-throughput (omic) data to preserve the emergent properties that appear in the cellular system when all molecular levels are interacting. We show here that this method applied to brain cancer data can uncover properties (i.e. molecules related to protective versus risky features in different types of brain cancers) that have been independently validated as survival markers, with potential important application in clinical practice.
Collapse
Affiliation(s)
- Raffaele Fronza
- Key Laboratory of Computational Biology, MPG-CAS PICB, Shanghai, China.
| | | | | | | |
Collapse
|
33
|
Güney Y, Hiçsönmez A, Yilmaz S, Adas YG, Andrieu MN. Gliosarcoma: a study of four cases. Rare Tumors 2010; 2:e37. [PMID: 21139839 PMCID: PMC2994509 DOI: 10.4081/rt.2010.e37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 05/10/2010] [Accepted: 05/11/2010] [Indexed: 11/23/2022] Open
Abstract
Gliosarcomas (GS) are highly malignant and rare tumors of the central nervous system with a poor prognosis. We report here on four patients with GS, the median survival for whom was 9.25 months. Prognosis of GS remains poor, and a multidisciplinary approach (surgery, radiation therapy, and chemotherapy) seems to be associated with slightly more prolonged survival times.
Collapse
Affiliation(s)
- Yildiz Güney
- Department of Radiation Oncology, Faculty of Medicine, Ankara University, Turkey
| | | | | | | | | |
Collapse
|
34
|
O6-methylguanine DNA methyltransferase status determined by promoter methylation and immunohistochemistry in gliosarcoma and their clinical implications. J Neurooncol 2010; 101:477-86. [PMID: 20556478 DOI: 10.1007/s11060-010-0267-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 05/30/2010] [Indexed: 10/19/2022]
Abstract
O(6)-methylguanine-DNA methyltransferase (MGMT) is known as a DNA repair protein, and loss of function in MGMT is related to an increase in survival in patients with malignant gliomas treated with alkylating agents. In the present study, we determined the status of MGMT using methylation-specific polymerase chain reaction (PCR) and immunohistochemistry on paraffin-embedded specimens in 12 human gliosarcomas, and these results were then related to overall survival (OS) and response to alkylating agents. The MGMT promoter was methylated in six patients. Immunostaining of MGMT was positive in 58.3% of patients. MGMT methylation status was correlated with immunostaining results in five patients (41.7%). The median OS and progression-free survival (PFS) of the whole population were 13.4 months [95% confidence interval (CI), 12.3-14.5 months] and 8.3 months (95% CI, 7.4-9.2 months), respectively. In patients with methylated MGMT promoter, median OS was 15.0 months, compared with 11.3 months in the unmethylated group. Median PFS of gliosarcoma patients was 10.3 months for the methylated group, whereas it was 7.3 months for the unmethylated group. On multivariate analysis, patients with methylated MGMT promoter had better prognosis than patients with unmethylated MGMT promoter with respect to OS and PFS (P = 0.045 and 0.034, respectively). However, there was no statistical significance between MGMT protein expression and survival. The results show that a significant fraction of gliosarcomas have MGMT promoter methylation and protein expression, and suggest that patient survival is associated with MGMT methylation status.
Collapse
|
35
|
Han SJ, Yang I, Otero JJ, Ahn BJ, Tihan T, McDermott MW, Berger MS, Chang SM, Parsa AT. Secondary gliosarcoma after diagnosis of glioblastoma: clinical experience with 30 consecutive patients. J Neurosurg 2010; 112:990-6. [PMID: 19817543 DOI: 10.3171/2009.9.jns09931] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Gliosarcoma can arise secondarily, after conventional adjuvant treatment of high-grade glioma. The current literature on the occurrence of secondary gliosarcoma (SGS) after glioblastoma multiforme (GBM) is limited, with only 12 reported cases. The authors present a large series of histologically confirmed SGSs, with follow-up to describe the clinical and radiological presentation, pathological diagnosis, and treatment outcomes. METHODS Gliosarcoma cases were identified using the University of California, San Francisco's Departments of Neurological Surgery and Neuropathology databases. Through a retrospective chart review, cases of gliosarcoma were considered SGS if the following inclusion criteria were met: 1) the patient had a previously diagnosed intracranial malignant glioma that did not have gliosarcoma components; and 2) the histopathological tissue diagnosis of the recurrence confirmed gliosarcoma according to the most current WHO criteria. Extensive review of clinical, surgical, and pathology notes was performed to gather clinical and pathological data on these cases. RESULTS Thirty consecutive patients in whom SGS had been diagnosed between 1996 and 2008 were included in the analysis. All patients had previously received a diagnosis of malignant glioma. For the initial malignant glioma, all patients underwent resection, and 25 patients received both external-beam radiation and chemotherapy. Three patients received radiotherapy alone, 1 patient was treated with chemotherapy alone, and 1 patient's tumor rapidly recurred as gliosarcoma, requiring surgical intervention prior to initiation of adjuvant therapy. The median time from diagnosis of the initial tumor to diagnosis of gliosarcoma was 8.5 months (range 0.5-25 months). All but 1 patient (who only had a biopsy) underwent a second operation for gliosarcoma; 8 patients went on to receive radiotherapy (4 had brachytherapy, 3 had external-beam radiation, and 1 had Gamma Knife surgery); and 14 patients received additional chemotherapy. The median length of survival from the time of gliosarcoma diagnosis was 4.4 months (range 0.7-46 months). The median survival from the time of the original GBM diagnosis was 12.6 months (range 5.7-47.4 months). Patients who had received concurrent and adjuvant temozolomide for GBM had worse outcomes than those who had not (4.3 and 10.5 months, respectively; p = 0.045). There was no difference in time to diagnosis of gliosarcoma in these 2 groups (8 and 8.5 months; p = 0.387). Two patients who had not received radiation therapy for GBM had an anecdotally very prolonged survival (20.9 and 46.4 months). CONCLUSIONS The data underscore the difficulty associated with management of this disease. The strikingly poor survival of patients with SGS who had previously received combined radiation and temozolomide chemotherapy for GBM may reflect a unique molecular profile of GBM that eventually recurs as SGS. Further work will be required, controlling for multiple prognostic factors with larger numbers of patients.
Collapse
Affiliation(s)
- Seunggu J Han
- Department of Neurological Surgery, University of California, San Francisco, California 94117, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Cheong JH, Kim CH, Kim JM, Oh YH. Transformation of intracranial anaplastic astrocytoma associated with neurofibromatosis type I into gliosarcoma: case report. Clin Neurol Neurosurg 2010; 112:701-6. [PMID: 20466481 DOI: 10.1016/j.clineuro.2010.04.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 03/19/2010] [Accepted: 04/18/2010] [Indexed: 11/17/2022]
Abstract
Gliosarcoma is an uncommon malignant brain tumor composed of distinct sarcomatous and malignant glial cell elements. These tumors are defined as a variant of glioblastoma, and it can be developed by progression of the malignant glial cell tumors or primary tumors. We report a rare case with gliosarcomatous recurrence of anaplastic astrocytoma with neurofibromatosis type 1 (NF-1) followed by chemoradiation therapy. A 26-year-old male patient was presented with headache. Five years before admission, he had been diagnosed with NF-1. Magnetic resonance imaging (MRI) showed a well-demarcated, enhanced lesion in the right frontal lobe and multiple enhanced lesions in the scalp, lower cervical, thoracic, and upper lumbar regions. He underwent an osteoplastic craniotomy with total tumor resection. Histopathology of the tumor showed findings corresponding with anaplastic astrocytoma. He was followed by radiotherapy and chemotherapy postoperatively. A month later, his spinal lesion was also resected and confirmed pathologically as plexiform neurofibroma. The subsequent follow-up period of 27 months was uneventful until he developed a generalized tonic-clonic seizure. MRI showed tumor recurrence in the original site of the tumor. Re-exploration was carried out. Pathological examination displayed a biphasic pattern of the glial and sarcomatous components suggesting gliosarcoma.
Collapse
Affiliation(s)
- Jin-Hwan Cheong
- Department of Neurosurgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | | | | | | |
Collapse
|
37
|
Han SJ, Yang I, Ahn BJ, Otero JJ, Tihan T, McDermott MW, Berger MS, Prados MD, Parsa AT. Clinical characteristics and outcomes for a modern series of primary gliosarcoma patients. Cancer 2010; 116:1358-66. [PMID: 20052717 DOI: 10.1002/cncr.24857] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Primary gliosarcoma (PGS) is a rare central nervous system tumor with limited experience reported in the literature. In the current study, the authors present a modern series of confirmed PGS cases treated in the era of magnetic resonance imaging (MRI), after the accepted glioblastoma management of resection, radiation, and temozolomide. METHODS Using a retrospective review, patients with confirmed PGS were identified (1996-2008). Cases were determined to be PGS by central pathology review using the 2007 World Health Organization criteria. Extensive chart review was performed to gather clinical and pathologic data on these cases. RESULTS All but 1 patient had undergone a preoperative MRI, with 1 patient receiving a computed tomography scan due to a cardiac pacemaker. A total of 10 patients received radiotherapy with concurrent and adjuvant temozolomide chemotherapy, and 8 patients received radiotherapy alone or in combination with other chemotherapeutic agents. In 2 patients, the history of adjuvant treatment could not be confirmed. The overall median survival was 13.9 months (range, 2.2-22.9 months). Patients with gliosarcomas resembling meningioma were found to have a significantly prolonged median survival compared with patients harboring gliosarcoma resembling glioblastoma multiforme (16 months vs 9.6 months; P = .011). However, no difference in survival was noted between patients who received concurrent radiotherapy and temozolomide compared with those who did not (10.4 months vs 13.9 months; P = .946). CONCLUSIONS The results of the current study support previous hypotheses that there are 2 distinct types of PGS. The type mimicking the appearance of a meningioma appears to carry a significantly more favorable prognosis, most likely due to an increased chance at achieving macroscopic total resection.
Collapse
Affiliation(s)
- Seunggu J Han
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
MAEDA D, MIYAZAWA T, TOYOOKA T, SHIMA K. Temporal Gliosarcoma With Extraneural Metastasis -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:343-5. [DOI: 10.2176/nmc.50.343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daisuke MAEDA
- Department of Neurosurgery, National Defense Medical College
| | | | | | - Katsuji SHIMA
- Department of Neurosurgery, National Defense Medical College
| |
Collapse
|
39
|
Melo JRT, Souza ALPBD, Reis RC, Almeida MACD. Infantile gliosarcoma. ARQUIVOS DE NEURO-PSIQUIATRIA 2009; 66:88-9. [PMID: 18392424 DOI: 10.1590/s0004-282x2008000100022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- José Roberto Tude Melo
- Hospitalar Universitário Professor Edgard Santos, Universidade Federal da Bahia (HUPES-UFBA) e Hospital São Rafael (HSR), Salvador BA, Brazil.
| | | | | | | |
Collapse
|
40
|
Demirci S, Akalin T, Islekel S, Ertan Y, Anacak Y. Multiple spinal metastases of cranial gliosarcoma: a case report and review of the literature. J Neurooncol 2008; 88:199-204. [PMID: 18317692 DOI: 10.1007/s11060-008-9550-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2007] [Accepted: 02/18/2008] [Indexed: 11/24/2022]
Abstract
Gliosarcoma is a rare brain tumor that consists of both glial and mesenchymal components. We report the case of a 68-year-old female with cranial gliosarcoma metastatic to the spinal cord. Initially, the patient was diagnosed with cranial gliosarcoma and treated with surgical resection followed by radiotherapy. Four months after she completed treatment, she presented with a sudden onset of hemiplegia. MRI (Magnetic Resonance Imaging) scan demonstrated two masses at the thoracic spinal cord. Immediate surgery was performed and the lesions were resected. No further therapy was recommended due to the poor condition of the patient. The patient subsequently died 3 months after diagnosis of the spinal cord metastases. There are about 20 reported cases of metastatic gliosarcoma and most focus on systemic metastases of gliosarcoma. Spinal cord metastases are, however, very rare and here we report such a case. Available literature on metastatic gliosarcoma was also reviewed.
Collapse
Affiliation(s)
- Senem Demirci
- Department of Radiation Oncology, Ege University Faculty of Medicine, 35100 Bornova, Izmir, Turkey.
| | | | | | | | | |
Collapse
|
41
|
Kozak KR, Mahadevan A, Moody JS. Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol 2008; 11:183-91. [PMID: 18780813 DOI: 10.1215/15228517-2008-076] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The epidemiology and natural history of adult gliosarcomas (GSMs), as well as patient and treatment factors associated with outcome, are ill defined. Patients over 20 years of age with GSM diagnosed from 1988 to 2004 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier survival analysis and Cox models were used to examine outcomes. Similar analyses were conducted for patients diagnosed with glioblastoma (GBM) over the same time period. GSM represented 2.2% of the 16,388 patients identified with either GSM or GBM. No significant differences between GSM and GBM were identified with respect to age, gender, race, tumor size, or use of adjuvant radiation therapy (RT). Patients with GSM were more likely to have temporal lobe involvement and undergo some form of tumor resection. The most important analyzed factors influencing GSM overall survival were age, extent of resection, and use of adjuvant RT. After adjusting for factors impacting overall survival, the prognosis for GSM appears slightly worse than for GBM (HR = 1.17, 95% CI, 1.05-1.31). GSM is a rare malignancy that presents very similarly to GBM with a slightly greater propensity for temporal lobe involvement. Optimal treatment remains to be defined. However, these retrospective findings suggest tumor excision, as opposed to biopsy only, and adjuvant RT may improve outcome. Despite therapy, prognosis remains dismal and outcomes may be inferior to those seen in GBM patients.
Collapse
Affiliation(s)
- Kevin R Kozak
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
| | | | | |
Collapse
|
42
|
Sanal HT, Bulakbasi N, Kocaoglu M, Onguru O, Chen L. Giant infantile gliosarcoma: magnetic resonance imaging findings. J Child Neurol 2008; 23:926-9. [PMID: 18403585 DOI: 10.1177/0883073808314897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gliosarcoma is an uncommon variant of glioblastoma multiforme, which is composed of gliomatous and sarcomatous elements. The tumor is rarely encountered in childhood. This case report presents the magnetic resonance imaging characteristics of a giant gliosarcoma in a 3-year-old girl. Size and location of the tumor are described.
Collapse
Affiliation(s)
- Hatice Tuba Sanal
- Department of Radiology, Gulhane Military Medical School, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
43
|
Scheithauer BW, Fuller GN, VandenBerg SR. The 2007 WHO classification of tumors of the nervous system: controversies in surgical neuropathology. Brain Pathol 2008; 18:307-16. [PMID: 18532929 PMCID: PMC8095595 DOI: 10.1111/j.1750-3639.2008.00179.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 04/11/2008] [Indexed: 02/05/2023] Open
Abstract
Controversy surrounds the recent 2007 WHO Classification of Tumours of the Nervous System. A number of nosologic issues remain to be resolved, some a reflection of conceptual disagreement, others the result of inadequate data to permit their definitive resolution. Among these and discussed herein are (i) the nosologic place of highly anaplastic oligoastrocytic tumors, (ii) the forms and significance of microvascular changes in high-grade gliomas, (iii) the makeup of the glioneuronal tumors category, (iv) the subclassification of pineal parenchymal tumors of intermediate type, and (v) the classification of principle forms of mesenchymal neoplasms, specifically hemangiopericytoma and solitary fibrous tumor. These issues and others are the substance of this and an upcoming companion article.
Collapse
Affiliation(s)
- Bernd W Scheithauer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | |
Collapse
|
44
|
Watanabe Y, Hotta T, Yoshioka H, Itou Y, Taniyama K, Sugiyama K. Primary diffuse leptomeningeal gliosarcomatosis. J Neurooncol 2007; 86:207-10. [PMID: 17628746 DOI: 10.1007/s11060-007-9459-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Accepted: 06/26/2007] [Indexed: 10/23/2022]
Abstract
We report a 48-year-old woman with primary diffuse leptomeningeal gliomatosis (PDLG) histologically diagnosed as gliosarcoma. She was admitted complaining of headache, numbness of the right arm, double vision, and visual field defects. Computerized tomography (CT) scans showed ventricular dilatation consistent with communicating hydrocephalus. Magnetic resonance imaging (MRI) revealed diffuse meningeal thickening and gadolinium enhancement without a definite intraparenchymal lesion. Whole-spine MRI demonstrated across-the-board dural thickening and gadolinium enhancement. Cytological examination showed atypical anaplastic cells. As no diagnosis could be made she underwent biopsy of the leptomeninges. Histological examination of the specimen returned a diagnosis of gliosarcoma. Despite chemotherapy and radiotherapy she died 11 months after admission. Autopsy findings included gliosarcoma in the leptomeninges and spinal cord without an underlying parenchymal tumor. To our knowledge, this is the first report of primary diffuse leptomeningeal gliosarcomatosis.
Collapse
Affiliation(s)
- Yosuke Watanabe
- Department of Neurosurgery and Institute for Clinical Research, National Hospital Organization, Kure medical center, 3-1 Aoyama, Kure City, Hiroshima, Japan.
| | | | | | | | | | | |
Collapse
|
45
|
Abstract
Gliosarcomas are bimorphic intraaxial tumors. Involvement of the skull base is highly unexpected. The authors present the case of a temporal lobe gliosarcoma with significant infratemporal fossa extension. This 55-year-old man presented with a 1-month history of severe progressive headache. Neurological examination was unremarkable except for bilateral papilledema. Magnetic resonance imaging revealed a 6-cm right temporal mass with extension into the infratemporal fossa. The patient underwent a right frontotemporal craniotomy together with drilling of the sphenoid ridge and middle fossa floor. The tumor consisted of intraaxial, intracranial as well as extradural, and extracranial components with extension to the posterolateral wall of the sphenoid sinus. It had a relatively well-circumscribed dissection plane. Gross-total resection was achieved, and the middle fossa floor was reconstructed using a rotated temporalis muscle flap. The postoperative course was uneventful except for hypesthesia in the distribution of the maxillary division of the right trigeminal nerve. The histopathological diagnosis was consistent with gliosarcoma. Radiotherapy and chemotherapy consisting of temozolomide were administered subsequently, and the patient was recurrence free 12 months after his initial diagnosis. In the presence of a mass lesion with both intraaxial and extracranial involvement, gliosarcoma should be considered among the differential diagnoses. Aggressive resection should be attempted, including the use of skull base surgical techniques to ensure an optimal outcome. The effect of skull base involvement to the overall treatment and outcome of patients with gliosarcomas would be difficult to determine given the rare occurrence of these lesions in such locations.
Collapse
Affiliation(s)
- Burak Sade
- Brain Tumor Institute, and Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | |
Collapse
|