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Frosch M, Demerath T, Fung C, Prinz M, Urbach H, Erny D, Taschner CA. Freiburg Neuropathology Case Conference : Headache, Mental Confusion and Mild Hemiparesis in a 68-year-old Patient. Clin Neuroradiol 2023; 33:1159-1164. [PMID: 37872367 PMCID: PMC10654210 DOI: 10.1007/s00062-023-01359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Affiliation(s)
- M Frosch
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - T Demerath
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C Fung
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - D Erny
- Department of Neuropathology, University of Freiburg, Freiburg, Germany
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, University of Freiburg, Freiburg, Germany.
- Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstr. 64, 79106, Freiburg, Germany.
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2
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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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3
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Gliosarcoma with direct involvement of the oculomotor nerve: Case report and literature review. Radiol Case Rep 2022; 17:1148-1153. [PMID: 35169418 PMCID: PMC8829493 DOI: 10.1016/j.radcr.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/22/2022] Open
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4
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Gandhi P, Khare R, Garg N, Mishra J. Can a signature molecular-profile define disparate survival in BRAF-positive Gliosarcoma and identify novel targets for therapeutic intervention? J Cancer Res Ther 2022; 18:224-230. [DOI: 10.4103/jcrt.jcrt_1900_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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5
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Chasing a rarity: a retrospective single-center evaluation of prognostic factors in primary gliosarcoma. Strahlenther Onkol 2021; 198:468-474. [PMID: 34939129 PMCID: PMC9038866 DOI: 10.1007/s00066-021-01884-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/21/2021] [Indexed: 11/17/2022]
Abstract
Background and purpose Primary gliosarcoma (GS) is a rare variant of IDH-wildtype glioblastoma multiforme. We performed a single-center analysis to identify prognostic factors. Patients and methods We analyzed the records of 26 patients newly diagnosed with primary WHO grade IV GS. Factors of interest were clinical and treatment data, as well as molecular markers, time to recurrence, and time to death. Results Median follow-up was 9 months (range 5–21 months). Gross total resection did not lead to improved survival, most likely due to the relatively small sample size. Low symptom burden at the time of diagnosis was associated with longer PFS (P = 0.023) and OS (P = 0.018). Median OS in the entire cohort was 12 months. Neither MGMT promoter hypermethylation nor adjuvant temozolomide therapy influenced survival, consistent with some previous reports. Conclusion In this retrospective study, patients exhibiting low symptom burden at diagnosis showed improved survival. None of the other factors analyzed were associated with an altered outcome.
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6
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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.
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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.
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7
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Qian Z, Zhang L, Hu J, Chen S, Chen H, Shen H, Zheng F, Zang Y, Chen X. Machine Learning-Based Analysis of Magnetic Resonance Radiomics for the Classification of Gliosarcoma and Glioblastoma. Front Oncol 2021; 11:699789. [PMID: 34490097 PMCID: PMC8417735 DOI: 10.3389/fonc.2021.699789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To identify optimal machine-learning methods for the radiomics-based differentiation of gliosarcoma (GSM) from glioblastoma (GBM). Materials and Methods This retrospective study analyzed cerebral magnetic resonance imaging (MRI) data of 83 patients with pathologically diagnosed GSM (58 men, 25 women; mean age, 50.5 ± 12.9 years; range, 16-77 years) and 100 patients with GBM (58 men, 42 women; mean age, 53.4 ± 14.1 years; range, 12-77 years) and divided them into a training and validation set randomly. Radiomics features were extracted from the tumor mass and peritumoral edema. Three feature selection and classification methods were evaluated in terms of their performance in distinguishing GSM and GBM: the least absolute shrinkage and selection operator (LASSO), Relief, and Random Forest (RF); and adaboost classifier (Ada), support vector machine (SVM), and RF; respectively. The area under the receiver operating characteristic curve (AUC) and accuracy (ACC) of each method were analyzed. Results Based on tumor mass features, the selection method LASSO + classifier SVM was found to feature the highest AUC (0.85) and ACC (0.77) in the validation set, followed by Relief + RF (AUC = 0.84, ACC = 0.72) and LASSO + RF (AUC = 0.82, ACC = 0.75). Based on peritumoral edema features, Relief + SVM was found to have the highest AUC (0.78) and ACC (0.73) in the validation set. Regardless of the method, tumor mass features significantly outperformed peritumoral edema features in the differentiation of GSM from GBM (P < 0.05). Furthermore, the sensitivity, specificity, and accuracy of the best radiomics model were superior to those obtained by the neuroradiologists. Conclusion Our radiomics study identified the selection method LASSO combined with the classifier SVM as the optimal method for differentiating GSM from GBM based on tumor mass features.
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Affiliation(s)
- Zenghui Qian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lingling Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jie Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuguang Chen
- School of Mathematical Sciences, Nankai University, Tianjin, China
| | - Hongyan Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huicong Shen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Zheng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuying Zang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuzhu Chen
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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8
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Prado RMDA, Tamura BP, Gomez GD. Optic pathway gliosarcoma: A very rare location for a rare disease. Radiol Case Rep 2021; 16:1665-1668. [PMID: 34007379 PMCID: PMC8111437 DOI: 10.1016/j.radcr.2021.04.001] [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: 03/02/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/22/2022] Open
Abstract
Gliosarcoma, a variant of glioblastoma, is a rare and aggressive tumor of the central nervous system (CNS) composed of glial and sarcomatous tissues. Up to now, there are only 2 reported cases of gliosarcoma of the optical pathway. We report a case from March 2018 of a 53-year-old male patient presented with 6 months’ of right fronto-orbital pulsatile headache, behavior changes, and visual loss. The MRI study showed an expansile optic pathway lesion involving the chiasm and right optic nerve. The diagnosis of gliosarcoma was obtained by open brain biopsy and immunohistochemical analysis. Although gliosarcoma is rare, it should be considered a differential diagnosis even in optic pathway tumors in older patients. The experience of the neuropathologist with a trained eye can be the differential in the accurate diagnostic process. Optic pathway, Gliosarcoma, Glioblastoma, Magnetic resonance imaging
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Affiliation(s)
- Renato Masson de Almeida Prado
- Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), SP 04024-002, Brazil
| | - Bruno Pierri Tamura
- Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), SP 04024-002, Brazil
| | - Gustavo Dalul Gomez
- Department of Diagnostic Imaging, Division of Neuroradiology, Universidade Federal de São Paulo (UNIFESP), SP 04024-002, Brazil
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9
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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.
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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
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10
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de Macedo Filho LJM, Barreto EG, Martins PLB, Filho ENS, Gerson G, de Albuquerque LAF. IDH1-mutant primary intraventricular gliosarcoma: Case report and systematic review of a rare location and molecular profile. Surg Neurol Int 2020; 11:372. [PMID: 33408906 PMCID: PMC7771479 DOI: 10.25259/sni_586_2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Gliosarcoma (GS) is classified as an IDH-wild-type variant of glioblastoma (GBM). While GS is already an unusual presentation of GBM, IDH1-mutant cases are especially rare. We present an IDH1-mutant primary intraventricular GS case report and a systematic review of the molecular profile in GS correlating to the prognostic and pathogenesis of IDH1/2 mutations. Case Description: A 44-years-old man presented with ongoing fatigue symptoms and a new-onset intense occipital headache. The patient complained of memory loss, dyscalculia, and concentration difficulties. An MRI revealed a bihemispheric intraventricular mass crossing the midline through the corpus callosum and infiltrating the trigone of the lateral ventricles, hypointense, and hyperintense on the T1- and T2-weighted image. We performed a microsurgical resection with a transparietal transsulcal approach; however, the contralateral mass was attached to vascular structures and we decided to reoperate the patient in another moment. The histopathological study showed a Grade IV tumor and the immunohistochemistry confirmed the diagnosis of GS. The patient presented progressive neurologic decline and died 45 days after the surgical approach. Conclusion: We did two systematic reviews studies from PubMed, EMBASE, MEDLINE, Cochrane, and SCOPUS databases, and included molecular and intraventricular studies of GS. We performed further meta-analysis using OpenMetaAnalyst™ software. We conducted a forest plot with the molecular profile of GS. When correlated IDH1 mutation versus tp53 mutation, we found an odds ratio (OR) of 0.018 (0.005–0.064) and P < 0.001. Moreover, we compared IDH1 mutation versus MGMT methylation (P = 0.006; OR = 0.138 [0.034–0.562]). The studies evaluating the molecular profile in GS prognostics are often extended from all GBMs despite specifics GBM variants (i.e., GS). We found a correlation between IDH1 mutation expression with tp53 and MGMT expression in GS, and future studies exploring this molecular profile in GS are strongly encouraged.
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Affiliation(s)
| | | | | | | | - Gunter Gerson
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceara, Brazil
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11
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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.
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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
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12
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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.
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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
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13
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Glioblastoma heterogeneity and the tumour microenvironment: implications for preclinical research and development of new treatments. Biochem Soc Trans 2019; 47:625-638. [PMID: 30902924 DOI: 10.1042/bst20180444] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 12/13/2022]
Abstract
Glioblastoma is the deadliest form of brain cancer. Aside from inadequate treatment options, one of the main reasons glioblastoma is so lethal is the rapid growth of tumour cells coupled with continuous cell invasion into surrounding healthy brain tissue. Significant intra- and inter-tumour heterogeneity associated with differences in the corresponding tumour microenvironments contributes greatly to glioblastoma progression. Within this tumour microenvironment, the extracellular matrix profoundly influences the way cancer cells become invasive, and changes to extracellular (pH and oxygen levels) and metabolic (glucose and lactate) components support glioblastoma growth. Furthermore, studies on clinical samples have revealed that the tumour microenvironment is highly immunosuppressive which contributes to failure in immunotherapy treatments. Although technically possible, many components of the tumour microenvironment have not yet been the focus of glioblastoma therapies, despite growing evidence of its importance to glioblastoma malignancy. Here, we review recent progress in the characterisation of the glioblastoma tumour microenvironment and the sources of tumour heterogeneity in human clinical material. We also discuss the latest advances in technologies for personalised and in vitro preclinical studies using brain organoid models to better model glioblastoma and its interactions with the surrounding healthy brain tissue, which may play an essential role in developing new and more personalised treatments for this aggressive type of cancer.
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