Gliosarcoma Associated with Neurofibromatosis Type I: A Case Report

Pediatric Gliosarcoma With and Without Neurofibromatosis Type 1: A Whole-exome Comparison of 2 Patients

Gliosarcoma is rare among pediatric patients and among individuals with Neurofibromatosis Type 1 (NF1). Here we compare 2 pediatric gliosarcoma patients, one of whom has NF1. We performed whole-exome sequencing, methylation, and copy number analysis on tumor and blood for both patients. Whole-exome sequencing showed higher mutational burden in the tumor of the patient without NF1. Copy number analysis showed differences in chromosomal losses/gains between the tumors. Neither tumor showed O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation. The NF1 patient survived without progression while the other expired. This is the first reported case of gliosarcoma in a child with NF1.

Gliosarcoma in a young patient with neurofibromatosis type 1. Case report

Introducción. La neurofibromatosis tipo 1 (NF1) es una condición autosómica dominante que presenta una expresividad fenotípica variable, con manifestaciones que van desde lesiones cutáneas hasta compromiso funcional. Se manifiesta clínicamente durante la infancia y la adolescencia; su gen codifica una proteína, la neurofibromina, que actúa como un supresor tumoral en condiciones normales regulando, a su vez, otra proteína que estimula el crecimiento y proliferación celular. En caso de alteración se podrían presentar diferentes procesos tumorales como el que se evidencia en un reducido número de casos. Presentación de caso. Paciente masculino de 20 años con NF1, quien presentaba lesiones cutáneas como manchas color café con leche y desarrolló un glioblastoma, lo cual sucede de manera infrecuente. Discusión. Para obtener el diagnóstico confirmado se incluyen métodos de inmunohistoquímica que contribuyen en gran medida al pronóstico puesto que la mediana de supervivencia global de los pacientes de glioblastoma es mayor en pacientes con NF1 que aquellos sin dicha entidad patológica. Conclusión. El diagnóstico temprano de las lesiones favorece un manejo a tiempo de la NF1. Estos pacientes requieren un manejo integral e interdisciplinar para favorecer su rehabilitación total.

Transformation of intracranial anaplastic astrocytoma associated with neurofibromatosis type I into gliosarcoma: case report

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.