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Saki A, Faghihi U, Baldé I. Differentiating Gliosarcoma from Glioblastoma: A Novel Approach Using PEACE and XGBoost to Deal with Datasets with Ultra-High Dimensional Confounders. Life (Basel) 2024; 14:882. [PMID: 39063635 PMCID: PMC11278037 DOI: 10.3390/life14070882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/28/2024] [Accepted: 06/28/2024] [Indexed: 07/28/2024] Open
Abstract
In this study, we used a recently developed causal methodology, called Probabilistic Easy Variational Causal Effect (PEACE), to distinguish gliosarcoma (GSM) from glioblastoma (GBM). Our approach uses a causal metric which combines Probabilistic Easy Variational Causal Effect (PEACE) with the XGBoost, or eXtreme Gradient Boosting, algorithm. Unlike prior research, which often relied on statistical models to reduce dataset dimensions before causal analysis, our approach uses the complete dataset with PEACE and the XGBoost algorithm. PEACE provides a comprehensive measurement of direct causal effects, applicable to both continuous and discrete variables. Our method provides both positive and negative versions of PEACE together with their averages to calculate the positive and negative causal effects of the radiomic features on the variable representing the type of tumor (GSM or GBM). In our model, PEACE and its variations are equipped with a degree d which varies from 0 to 1 and it reflects the importance of the rarity and frequency of the events. By using PEACE with XGBoost, we achieved a detailed and nuanced understanding of the causal relationships within the dataset features, facilitating accurate differentiation between GSM and GBM. To assess the XGBoost model, we used cross-validation and obtained a mean accuracy of 83% and an average model MSE of 0.130. This performance is notable given the high number of columns and low number of rows (code on GitHub).
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Affiliation(s)
- Amir Saki
- Département de Mathématiques et d’Informatique, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada;
| | - Usef Faghihi
- Département de Mathématiques et d’Informatique, Université du Québec à Trois-Rivières, Trois-Rivières, QC G8Z 4M3, Canada;
| | - Ismaila Baldé
- Département de Mathématiques et de Statistique, Faculté des Sciences, Université de Moncton, Moncton, NB E1A3E9, Canada;
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Wang Y, Zhang Z. A case report: Gliosarcoma associated with a germline heterozygous mutation in MSH2. Front Neurol 2024; 15:1388263. [PMID: 38784900 PMCID: PMC11112698 DOI: 10.3389/fneur.2024.1388263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Gliosarcoma is a rare subtype of glioblastoma (GBM) with a shorter medical history and a worse prognosis compared to other Grade 4 gliomas. Most gliosarcomas are sporadic, but it is undeniable that a small percentage are linked to germline mutations and several inherited cancer susceptibility syndromes, including Lynch Syndrome (LS). The authors present a case of a primary mismatch repair-deficient gliosarcoma in LS. A 54-year-old Chinese male patient was admitted to the hospital with a history of facial asymmetry for over 1 month and right temporo-occipital pain for 5 days. Head MRI revealed a complex mass lesion in the right frontoparietal region, consisting of cystic and solid components. The patient's history of colon malignancy and family history of rectal carcinoma were noteworthy. Postoperative pathology indicated the presence of gliosarcoma with high-frequency microsatellite instability (MSI-H) and mismatch repair deficiency (MMRD). Further genetic testing results confirmed a germline heterozygous mutation in MSH2, which is considered the gold standard for diagnosing LS. This case report enriches the existing literature on germline MSH2 mutations and gliosarcomas. It highlights the importance for neurosurgeons to consider possible hereditary disorders when treating patients with a history of concurrent tumors outside the nervous system. Genetic testing is crucial for further identification of such disorders.
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Affiliation(s)
- Yuhan Wang
- Medical School, Nanjing University, Nanjing, China
| | - Zhiyuan Zhang
- Department of Neurosurgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Yuan F, Zhao Q, Zeng Y, Liao XF, Li J, Liu B, Kou JF, Zhong X, Wu XH, Zhang JF, Ren WX. A COX2-targeting cancer-specific fluorescent probe for hydrogen sulfide detection in living cells, Caenorhabditis elegans, and zebrafish. Analyst 2024; 149:1489-1495. [PMID: 38314794 DOI: 10.1039/d3an01847d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
A novel cyclooxygenase-2 (COX-2) targeted H2S-activated cancer-specific fluorescent probe, namely, COX2-H2S, was designed and synthesized, with naphthalimide as the fluorophore and indomethacin as the targeting group. This H2S-sensing probe was developed to differentiate tumor cells from normal cells and was tested in living cells, Caenorhabditis elegans (C. elegans), and zebrafish. The probe could successfully be used for imaging endogenous and exogenous H2S in living cells, demonstrating high sensitivity and specificity and strong anti-interference. COX2-H2S had the ability to not only discern cancer cells from normal cells but also specifically recognize 9L/lacZ cells from other glioblastoma cells (U87-MG and LN229). It could also be successfully applied for the fluorescent live imaging of H2S in both C. elegans and zebrafish.
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Affiliation(s)
- Fengying Yuan
- Department of Radiology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu 610000, China
| | - Qiao Zhao
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650500, China.
| | - Yanyan Zeng
- Department of Radiology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
| | - Xu Fang Liao
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650500, China.
| | - Jiali Li
- Department of Radiology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
| | - Bo Liu
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650500, China.
| | - Jun Feng Kou
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650500, China.
| | - Xiaolin Zhong
- Department of Gastroenterology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
| | - Xiang Hua Wu
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650500, China.
| | - Jun Feng Zhang
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650500, China.
| | - Wen Xiu Ren
- Department of Radiology, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
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Rahban M, Joushi S, Bashiri H, Saso L, Sheibani V. Characterization of prevalent tyrosine kinase inhibitors and their challenges in glioblastoma treatment. Front Chem 2024; 11:1325214. [PMID: 38264122 PMCID: PMC10804459 DOI: 10.3389/fchem.2023.1325214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024] Open
Abstract
Glioblastoma multiforme (GBM) is a highly aggressive malignant primary tumor in the central nervous system. Despite extensive efforts in radiotherapy, chemotherapy, and neurosurgery, there remains an inadequate level of improvement in treatment outcomes. The development of large-scale genomic and proteomic analysis suggests that GBMs are characterized by transcriptional heterogeneity, which is responsible for therapy resistance. Hence, knowledge about the genetic and epigenetic heterogeneity of GBM is crucial for developing effective treatments for this aggressive form of brain cancer. Tyrosine kinases (TKs) can act as signal transducers, regulate important cellular processes like differentiation, proliferation, apoptosis and metabolism. Therefore, TK inhibitors (TKIs) have been developed to specifically target these kinases. TKIs are categorized into allosteric and non-allosteric inhibitors. Irreversible inhibitors form covalent bonds, which can lead to longer-lasting effects. However, this can also increase the risk of off-target effects and toxicity. The development of TKIs as therapeutics through computer-aided drug design (CADD) and bioinformatic techniques enhance the potential to improve patients' survival rates. Therefore, the continued exploration of TKIs as drug targets is expected to lead to even more effective and specific therapeutics in the future.
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Affiliation(s)
- Mahdie Rahban
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Joushi
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamideh Bashiri
- Physiology Research Center, Institute of Neuropharmacology, Department of Physiology and Pharmacology, Medical School, Kerman University of Medical Sciences, Kerman, Iran
| | - Luciano Saso
- Department of Physiology and Pharmacology “Vittorio Erspamer”, Sapienza University, Rome, Italy
| | - Vahid Sheibani
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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5
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Li A, Hancock JC, Quezado M, Ahn S, Briceno N, Celiku O, Ranjan S, Aboud O, Colwell N, Kim SA, Nduom E, Kuhn S, Park DM, Vera E, Aldape K, Armstrong TS, Gilbert MR. TGF-β and BMP signaling are associated with the transformation of glioblastoma to gliosarcoma and then osteosarcoma. Neurooncol Adv 2024; 6:vdad164. [PMID: 38292240 PMCID: PMC10825841 DOI: 10.1093/noajnl/vdad164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Background Gliosarcoma, an isocitrate dehydrogenase wildtype (IDH-WT) variant of glioblastoma, is defined by clonal biphasic differentiation into gliomatous and sarcomatous components. While the transformation from a glioblastoma to gliosarcoma is uncommon, the subsequent transformation to osteosarcoma is rare but may provide additional insights into the biology of these typically distinct cancers. We observed a patient initially diagnosed with glioblastoma, that differentiated into gliosarcoma at recurrence, and further evolved to osteosarcoma at the second relapse. Our objective was to characterize the molecular mechanisms of tumor progression associated with this phenotypic transformation. Methods Tumor samples were collected at all 3 stages of disease and RNA sequencing was performed to capture their transcriptomic profiles. Sequential clonal evolution was confirmed by the maintenance of an identical PTEN mutation throughout the tumor differentiation using the TSO500 gene panel. Publicly available datasets and the Nanostring nCounter technology were used to validate the results. Results The glioblastoma tumor from this patient possessed mixed features of all 3 TCGA-defined transcriptomic subtypes of an IDH-WT glioblastoma and a proportion of osteosarcoma signatures were upregulated in the original tumor. Analysis showed that enhanced transforming growth factor-β (TGF-β) and bone morphogenic protein signaling was associated with tumor transformation. Regulatory network analysis revealed that TGF-β family signaling committed the lineage tumor to osteogenesis by stimulating the expression of runt-related transcription factor 2 (RUNX2), a master regulator of bone formation. Conclusions This unusual clinical case provided an opportunity to explore the modulators of longitudinal sarcomatous transformation, potentially uncovering markers indicating predisposition to this change and identification of novel therapeutic targets.
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Affiliation(s)
- Aiguo Li
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - John C Hancock
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Susie Ahn
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Orieta Celiku
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Surabhi Ranjan
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Orwa Aboud
- Department of Neurology and Neurological Surgery, University of California, Davis, Sacramento, California, USA
| | - Nicole Colwell
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Sun A Kim
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Edjah Nduom
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Maryland, USA
| | - Skyler Kuhn
- Research Technology Branch, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - Deric M Park
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ken Aldape
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, Maryland, USA
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La Torre D, Della Torre A, Lo Turco E, Longo P, Pugliese D, Lacroce P, Raudino G, Romano A, Lavano A, Tomasello F. Primary Intracranial Gliosarcoma: Is It Really a Variant of Glioblastoma? An Update of the Clinical, Radiological, and Biomolecular Characteristics. J Clin Med 2023; 13:83. [PMID: 38202090 PMCID: PMC10779593 DOI: 10.3390/jcm13010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Gliosarcomas (GS) are sporadic malignant tumors classified as a Glioblastoma (GBM) variant with IDH-wild type phenotype. It appears as a well-circumscribed lesion with a biphasic, glial, and metaplastic mesenchymal component. The current knowledge about GS comes from the limited literature. Furthermore, recent studies describe peculiar characteristics of GS, such as hypothesizing that it could be a clinical-pathological entity different from GBM. Here, we review radiological, biomolecular, and clinical data to describe the peculiar characteristics of PGS, treatment options, and outcomes in light of the most recent literature. A comprehensive literature review of PubMed and Web of Science databases was conducted for articles written in English focused on gliosarcoma until 2023. We include relevant data from a few case series and only a single meta-analysis. Recent evidence describes peculiar characteristics of PGS, suggesting that it might be a specific clinical-pathological entity different from GBM. This review facilitates our understanding of this rare malignant brain tumor. However, in the future we recommend multi-center studies and large-scale metanalyses to clarify the biomolecular pathways of PGS to develop new specific therapeutic protocols, different from conventional GBM therapy in light of the new therapeutic opportunities.
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Affiliation(s)
- Domenico La Torre
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Attilio Della Torre
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Erica Lo Turco
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Prospero Longo
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Dorotea Pugliese
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Paola Lacroce
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Giuseppe Raudino
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Alberto Romano
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Angelo Lavano
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Francesco Tomasello
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
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Matute-González M, Mosteiro-Cadaval A, Vidal-Robau N, Páez-Carpio A, Valduvieco I, Pineda E, González JJ, Aldecoa I, Oleaga L. Clinicopathological and Neuroimaging Features of Primary Gliosarcoma: A Case Series and Review of Literature. World Neurosurg 2023; 178:e480-e488. [PMID: 37516148 DOI: 10.1016/j.wneu.2023.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Gliosarcoma (GS) is a rare primary high-grade brain neoplasm with a poor prognosis and challenging surgical resection. Although it is now considered a morphologic variant of IDH-wildtype glioblastoma (World Health Organization Classification of Tumours 2021), GS may display peculiarities that hamper both surgical and oncological management. METHODS In this retrospective study, we searched our registry for histologically confirmed GS patients between 2006 and 2020. Cases were reviewed for clinical information, pathologic characteristics, imaging findings, management, and outcome. RESULTS 21 patients with histologically confirmed GS were identified with a median age of 62 years. Twelve were men and 9 women. The temporal lobe was the most common location (9 patients, 42.9%). Nineteen patients underwent surgical resection, and only 4 (19%) demonstrated gross total resection on postsurgical MRI, with an overall median survival of 7 months (range, 0.5-37). Diagnostic MRI demonstrated heterogenous lesions with necrotic-cystic areas and a ring-enhancement pattern. Only 1 case of extracranial extension was seen in our sample, and no patient showed distant metastases. CONCLUSIONS The rarity of primary GS and the absence of specific therapeutic guidelines represent a significant clinical challenge. Our study provides a comprehensive analysis of clinical and neuroimaging characteristics in a real-world patient cohort and compares our findings with the available literature.
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Affiliation(s)
- Mario Matute-González
- Department of Neuroradiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | | | - Nuria Vidal-Robau
- Department of Pathology, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Páez-Carpio
- Department of Neuroradiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Izaskun Valduvieco
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Estela Pineda
- Department of Oncology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - José Juan González
- Department of Neurosurgery, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Iban Aldecoa
- Department of Pathology, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Neurological Tissue Bank of the Biobank-IDIBAPS-FCRB, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Department of Neuroradiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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Alghamdi KT, Ashqar AA, Alamoudi A, Alzahrani A, Samkari A, Kutub H. Gliosarcoma Invading the Temporal Bone, Temporalis Muscle, and Skull Base. Cureus 2023; 15:e42319. [PMID: 37614263 PMCID: PMC10443122 DOI: 10.7759/cureus.42319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
Gliosarcoma (GS) is a primary central nervous system tumor. It is an unusual type of glioblastoma multiforme (GBM) and rarely invades the skull base. It has a biomorphic tissue pattern with rapid alternation zones of glial and mesenchymal differentiation. We report the case of a 62-year-old male who presented with a one-month history of unsteady gait associated with dizziness. Brain MRI showed a right temporal mass that invaded the skull base with perilesional edema and a significant mass effect on the right lateral ventricle. The patient underwent a right-sided frontotemporal craniotomy with gross total resection. The pathology confirmed the diagnosis of GS. Postoperatively, the patient had an uneventful recovery with no complications and was discharged two days post-surgery.
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Affiliation(s)
- Khalid T Alghamdi
- Neurosurgery, King Faisal Specialist Hospital and Reseach Centre, Riyadh, SAU
| | - Alaa A Ashqar
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ahmad Alamoudi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Abdullah Alzahrani
- General Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Alaa Samkari
- Pathology and Laboratory Medicine, King Abdulalziz Medical City, Jeddah, SAU
| | - Hussam Kutub
- Neurosurgery, King Abdulaziz Medical City, Jeddah, SAU
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Achi J, Achi XW, Veintimilla P, Cueva J. Unusual extraneural metastasis of glioblastoma. Surg Neurol Int 2023; 14:218. [PMID: 37404487 PMCID: PMC10316183 DOI: 10.25259/sni_191_2023] [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] [Received: 02/26/2023] [Accepted: 06/10/2023] [Indexed: 07/06/2023] Open
Abstract
Background Glioblastoma (GB) is the most common and aggressive malignant brain tumor in adults. Extracranial metastases are very rare, been described in the lungs, soft tissue, or the intraspinal space. Case Description Through a PubMed-based bibliographic search, the authors reviewed the cases reported in the literature to date, emphasizing the epidemiology and pathophysiology of this rare condition. A clinical case of a 46-year-old man with an initial diagnosis of gliosarcoma, who received complete surgical and adjuvant treatment and later recurred as GB with incidental finding of a lung tumor, whose pathology reported metastasis of the primary, is illustrated. Conclusion Understanding the pathophysiology, it is likely that the incidence of extraneural metastases may continue to increase. Considering improvements in diagnostic techniques that allow early diagnosis, as well as advances in neurosurgical therapy and multimodal management with the aim of improving patient survival, the period in which malignant cells can spread and form extracranial metastases could increase. When screening should be performed to detect metastases in these patients is still not clear. The neuro-oncologists should pay attention to the systematic survey for extraneural metastasis of the GB. Timely detection and early treatment improve overall quality of patients' life.
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Affiliation(s)
- Jimmy Achi
- Department of Neurosurgery, Hospital Clínica Kennedy, Guayaquil, Ecuador
| | - Xavier Wong Achi
- Department of Neurosurgery, National Institute of Neurology and Neurosurgery Manuel Velasco Suarez, Mexico City, Mexico
| | - Paula Veintimilla
- Department of Medicine, Universidad Espíritu Santo, Samborondon, Ecuador
| | - Janina Cueva
- Department of General Surgery, Hospital Clínica Kennedy, Guayaquil, Ecuador
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Baisiwala S, Ko M, Zubair H, Li K, Vivas AC, Everson R, Liau L, Bari A, Patel KS. Metastatic secondary gliosarcoma: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE232. [PMID: 37218733 PMCID: PMC10550647 DOI: 10.3171/case232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/06/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Gliosarcoma is a rare and highly malignant cancer of the central nervous system with the ability to metastasize. Secondary gliosarcoma, or the evolution of a spindle cell-predominant tumor after the diagnosis of a World Health Organization grade IV glioblastoma, has also been shown to metastasize. There is little information on metastatic secondary gliosarcoma. OBSERVATIONS The authors present a series of 7 patients with previously diagnosed glioblastoma presenting with recurrent tumor and associated metastases with repeat tissue diagnosis consistent with gliosarcoma. The authors describe the clinical, imaging, and pathological characteristics in addition to carrying out a systematic review on metastases in secondary gliosarcoma. LESSONS The present institutional series and the systematic review of the literature show that metastatic secondary gliosarcoma is a highly aggressive disease with a poor prognosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kunal S. Patel
- Department of Neurosurgery and
- Brain Tumor Imaging Laboratory, Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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11
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Liu J, Li C, Wang Y, Ji P, Guo S, Zhai Y, Wang N, Xu M, Wang J, Wang L. Prognostic and predictive factors of secondary gliosarcoma: A single-institution series of 18 cases combined with 89 cases from literature. Front Oncol 2023; 12:1026747. [PMID: 36798692 PMCID: PMC9927223 DOI: 10.3389/fonc.2022.1026747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Secondary gliosarcomas (SGS) are rare malignancies that are diagnosed subsequent to pre-existing glioma. Clinical features and optimal treatment strategies for SGS have not been conclusively established. This study aimed to assess the clinicopathological features and outcomes of SGS. Methods We assessed the clinicopathological features and outcomes of SGS via retrospective analysis of data for SGS patients at Tangdu Hospital. Data from SGS patients in prior publications were also analyzed in accordance with PRISMA guidelines. Results Eighteen SGS patients who had been treated at Tangdu Hospital between 2013 and 2020 were enrolled in this study. Additional 89 eligible SGS patients were identified from 39 studies. The median age for the patients was 53 years old, and the most common location was the temporal lobe. The most common initial diagnosis was glioblastoma (GBM) (72.0%). Radiology revealed enhanced masses in 94.8% (73/77) of patients. Ten patients (10/107, 9.35%) had extracranial metastases at or after SGS diagnosis. Patients with initial diagnosis of non-GBM and who were younger than 60 years of age were significantly associated with a long duration of disease progression to SGS. After SGS diagnosis, patients with initial non-GBM diagnosis, gross total resection and chemoradiotherapy exhibited prolonged survival outcomes. Patients who had been initially diagnosed with GBM and received both chemoradiotherapy and active therapy after disease progression to SGS, had a significantly longer overall survival than patients who did not. Conclusion Initial diagnosis of GBM was a poor prognostic factor for SGS. Patients who underwent gross total resection and chemoradiation had better overall survival outcomes than those who did not. However, during treatment, clinicians should be cognizant of possible extracranial metastases.
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Affiliation(s)
- Jinghui Liu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chen Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Peigang Ji
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Shaochun Guo
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yulong Zhai
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Na Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Meng Xu
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Julei Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China,*Correspondence: Julei Wang, ; Liang Wang,
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China,Innovation Center for Advanced Medicine, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China,*Correspondence: Julei Wang, ; Liang Wang,
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NAKAGAKI Y, KAI K, KOMOHARA Y, TAKEZAKI T, KURODA J, SHINOJIMA N, SHIMOMURA M, KAWAKAMI F, MIKAMI Y, MUKASA A. Gliosarcoma with Systemic Metastasis Showing Favorable Response to Ifosfamide, Carboplatin, and Etoposide Chemotherapy: An Autopsy Case Report. NMC Case Rep J 2022; 9:263-268. [PMID: 36186622 PMCID: PMC9484818 DOI: 10.2176/jns-nmc.2022-0075] [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: 03/08/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022] Open
Abstract
Gliosarcoma is a rare malignant neoplasm. It accounts for approximately 2% of all glioblastomas. To date, there is no established treatment method for gliosarcoma, and a variety of therapies, such as surgical resection, radiotherapy, and chemotherapy, are typically employed. Here, we describe a patient with gliosarcoma who, despite multiple tumor metastases throughout the body, including the lungs and lymph nodes, achieved a relatively long survival due to salvage therapy with local irradiation and remarkably effective chemotherapy with low-dose ifosfamide, carboplatin, and etoposide therapy. When the patient died, we performed autopsy and confirmed the nature of the primary and metastatic tumor cells that had spread throughout the patient's body. Clinical and systemic histological studies also suggested the possibility of re-metastasis to the brain from systemic metastatic foci. Gliosarcoma appears to have characteristics similar to sarcoma as well as a higher risk of systemic metastasis. Therefore, a careful follow-up is necessary in such patients.
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Affiliation(s)
- Yuki NAKAGAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Keitaro KAI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshihiro KOMOHARA
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Tatsuya TAKEZAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Junichiro KURODA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Naoki SHINOJIMA
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Mari SHIMOMURA
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Fumi KAWAKAMI
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshiki MIKAMI
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Akitake MUKASA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
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Vuong HG, Dunn IF. Primary versus secondary gliosarcoma: a systematic review and meta-analysis. J Neurooncol 2022; 159:195-200. [PMID: 35768633 DOI: 10.1007/s11060-022-04057-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Gliosarcomas are extremely rare malignant brain tumors, which can be classified as primary gliosarcoma (PGS) if the tumors arise de novo or secondary gliosarcoma (SGS) in patients who had previously been treated for glioblastoma. Given their rarity, it is unclear if PGS is clinically and genetically different from SGS. This meta-analysis aimed to investigate the clinicopathological features, prognostic survivals, and molecular profiles of these rare tumors. METHODS We searched PubMed and Web of Science for relevant studies. Odds ratio (OR), hazard ratio (HR), and their 95% confidence intervals (CI) were pooled using the random-effect model. RESULTS We included eight studies with 239 PGS and 79 SGS for meta-analyses. Compared to PGS, SGS occurred at a younger age and had lower rates of gross total resection and radiation therapy. Bevacizumab was more commonly administered in SGS. SGS patients had a significantly worse PFS (HR 0.60; 95% CI 0.40-0.89) and OS (HR 0.46; 95% CI 0.31-0.68) in comparison to PGS. The incidences of EGFR mutation, IDH mutation, and MGMT methylation were not statistically different between PGS and SGS. CONCLUSION Our results demonstrated that PGS and SGS had distinct clinicopathological profiles and prognoses but shared similar genetic profiles. This study facilitates our understanding of how these two malignant brain tumors behave clinically, but future studies will be required to elucidate the genetic pathways of PGS and SGS.
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Affiliation(s)
- Huy Gia Vuong
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Ian F Dunn
- Department of Neurosurgery, Oklahoma University Health Sciences Center, Oklahoma City, OK, 73104, USA.
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Fan H, Yu Y, Du J, Liu L, Luo Y, Yu H, Liao X. Computed Tomography, Magnetic Resonance Imaging, and Pathological Features of Gliosarcoma. Neuropsychiatr Dis Treat 2022; 18:2577-2589. [PMID: 36387942 PMCID: PMC9642797 DOI: 10.2147/ndt.s386616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate the clinical, imaging, and pathological features of gliosarcoma. METHODS The clinical data of 14 patients with gliosarcoma confirmed by surgery and pathology at our hospital between 2010 and 2021 were analyzed retrospectively, and the relevant literature was reviewed. RESULTS In all 14 cases, the gliosarcoma was located in the supratentorial brain parenchyma and involved a single lesion. There were more male patients (64.3%) than female patients (35.7%), and 57.1% of all the patients were 40-60 years of age. The prognosis of all 14 patients was poor, and the average survival time was approximately seven months. The computed tomography findings revealed mostly mixed density lesions, and some cases were complicated with bleeding. The magnetic resonance imaging revealed irregularly shaped mass lesions of different sizes, with uneven or circular enhancement. Cystic degeneration and necrosis could be seen in all the masses, some of which showed signs of bleeding and were surrounded by different degrees of edema and space-occupying effects. The pathological examination revealed that the tumors had bidirectional differentiation of the glial and sarcoma components, while the immunohistochemistry examination revealed glial fibrillary acidic protein-positive and reticular fiber-positive staining in the sarcoma. CONCLUSION The clinical manifestations of gliosarcoma are nonspecific, but imaging reveals that the condition has certain characteristics, typically consisting of a huge supratentorial mass, with an irregular heterogeneous periphery or obvious mass-like augmentation after enhancement. The final diagnosis depends on the results of a pathological examination.
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Affiliation(s)
- Haiqing Fan
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, 550004, People's Republic of China
| | - Yue Yu
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, 550004, People's Republic of China
| | - Jinhui Du
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, 550004, People's Republic of China
| | - Likun Liu
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, 550004, People's Republic of China
| | - Yilin Luo
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, 550004, People's Republic of China
| | - Hui Yu
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, 550004, People's Republic of China
| | - Xin Liao
- Department of Medical Imaging, The Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, 550004, People's Republic of China
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