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Wapshott T, Schammel CMG, Schammel DP, Rezeanu L, Lynn M. Primary undifferentiated sarcoma of the meninges: A case report and comprehensive review of the literature. J Clin Neurosci 2018; 54:128-135. [PMID: 29793776 DOI: 10.1016/j.jocn.2018.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/23/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND IMPORTANCE Sarcomas make up 1% of all cases of adult cancer, with 5-10% of those classified as undifferentiated pleomorphic sarcomas (UPS/PUS) and 0.1-4.3% primary intracranial sarcomas. Intracranial undifferentiated sarcoma is characterized by an earlier age of onset and generally poorer prognosis compared to extracranial undifferentiated sarcomas. Current therapies involve surgical excision with wide margins and radiotherapy, with minimal data available regarding the efficacy of chemotherapy. CASE DESCRIPTION A 79-year-old man with a history of remote superficial bladder cancer presented with a large frontal scalp lesion. A biopsy was initially attempted by a dermatologist in the outpatient setting, but a follow-up CT scan revealed a skull-eroding, enhancing soft tissue lesion. Neurosurgical treatment revealed an undifferentiated sarcoma. The patient underwent adjuvant radiation therapy of 59.4 Gy fractionated over 45 days following surgery. Follow-up brain MRIs at 1-, 6-, 9-, 12-, 15-, 21-, and 27 months after surgery have not shown any indications of local recurrence or tumor metastasis. Despite the high propensity that undifferentiated sarcomas have for recurrence and metastasis and the patient's advanced age, this patient remains uniquely disease-free. CONCLUSION We provide a description of an unusual case and comprehensive literature review of UPS to clarify the hallmarks of the disease, identify the difficulties in diagnosis, and provide a summary of therapies employed in the literature with their corresponding patient outcomes.
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Affiliation(s)
- Taylor Wapshott
- University of South Carolina School of Medicine-Greenville, 607 Grove Road, Greenville, SC 29605, USA.
| | | | - David P Schammel
- Pathology Associates, 8 Memorial Medical Court, Greenville, SC 29605, USA.
| | - Luminita Rezeanu
- Pathology Associates, 8 Memorial Medical Court, Greenville, SC 29605, USA.
| | - Michael Lynn
- Southeastern Neurosurgical and Spine Institute, Greenville Health System, 111 Doctor's Drive, Greenville, SC 29605, USA.
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Sieg EP, Stepanyan H, Payne R, Frauenhoffer E, Specht CS, Langan S, Rizk E. Intraventricular Undifferentiated Pleomorphic Sarcoma: A Case Report. Cureus 2016; 8:e876. [PMID: 28003940 PMCID: PMC5156626 DOI: 10.7759/cureus.876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Undifferentiated pleomorphic sarcoma is a histologic diagnosis based on cell morphology. These tumors are found throughout the body. They are rarely found in the central nervous system and almost never occur as a primary intraventricular tumor. We present the unusual case of a 68-year-old woman with an intraventricular undifferentiated pleomorphic sarcoma. We go on to discuss the clinical presentation, radiographic characteristics, and management paradigm for these rare lesions. Our patient presented with acute confusion, inability to balance a checkbook, and gait imbalance. CT and MRI demonstrated a 4 x 3.6 x 3.6 cm enhancing lesion in the left lateral ventricle abutting the foramen of Monro. Pathology revealed an undifferentiated pleomorphic sarcoma.
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Affiliation(s)
- Emily P Sieg
- Department of Neurosurgery, Penn State Hershey Medical Center
| | | | - Russell Payne
- Department of Neurosurgery, Penn State Hershey Medical Center
| | | | | | - Sara Langan
- Department of Neurosurgery, Penn State Hershey Medical Center
| | - Elias Rizk
- Department of Neurosurgery, Penn State Hershey Medical Center
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Kim BJ, Kim JH, Chung HS, Kwon TH. Intracranial Undifferentiated Sarcoma Arising from a Low-Grade Glioma: A Case Report and Literature Review. J Korean Neurosurg Soc 2015; 57:469-72. [PMID: 26180618 PMCID: PMC4502247 DOI: 10.3340/jkns.2015.57.6.469] [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: 02/27/2014] [Revised: 03/14/2014] [Accepted: 06/10/2014] [Indexed: 12/30/2022] Open
Abstract
Undifferentiated sarcomas are rarely identified in the intracranial region. A 23-year-old man was admitted with a chief complaint of headache. Initial magnetic resonance images showed signs of low-grade glioma in the frontal lobe. Stereotactic biopsy was performed, and a diagnosis of diffuse astrocytoma was confirmed. Three months later, the patient presented with a high-grade tumor as seen on imaging studies. He underwent total resection of the tumor and histopathological tests identified an undifferentiated sarcoma. The patient died eight months later due to massive tumor bleeding. To the best of our knowledge, this is the first report of undifferentiated sarcoma arising from low-grade glioma without any chemotherapy or radiotherapy.
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Affiliation(s)
- Bum-Joon Kim
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Jong-Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Hung-Seob Chung
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Seoul, Korea
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Mahore A, Ramdasi R, Dange N, Epari S. Malignant fibrous histiocytoma of the skull base: A neurosurgical nuance. Asian J Neurosurg 2015; 10:135-8. [PMID: 25972949 PMCID: PMC4421955 DOI: 10.4103/1793-5482.154981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 69-year-old male, treated for colonic carcinoma 15 years back, presented to our services with status epilepticus. He had complaints of headache and vomiting for 7 days prior to presentation. Computed tomography and magnetic resonance imaging of the brain revealed heterogeneous, lobulated and osteolytic tumor involving middle and posterior cranial fossa. Excision of the tumor was planned in two stages. Middle fossa component was removed through right temporobasal approach. Histopathology was suggestive of malignant fibrous histiocytoma. Patient succumbed to pneumonia and septicemia in the postoperative period. Pathology, clinical features and therapeutic challenges of this clinical entity have been briefly reviewed.
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Affiliation(s)
- Amit Mahore
- Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
| | - Raghvendra Ramdasi
- Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
| | - Nitin Dange
- Department of Neurosurgery, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Parel, Mumbai, Maharashtra, India
| | - Sridhar Epari
- Department of Neuropathology, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Zhang GB, Li J, Zhang PF, Han LJ, Zhang JT. Radiation-induced malignant fibrous histiocytoma of the occipital: a case report. World J Surg Oncol 2014; 12:98. [PMID: 24742094 PMCID: PMC3999727 DOI: 10.1186/1477-7819-12-98] [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: 11/06/2013] [Accepted: 04/07/2014] [Indexed: 11/10/2022] Open
Abstract
Malignant fibrous histiocytoma (MFH) is a rare neoplasm exhibiting a propensity for aggressive clinical behavior. Effective treatment modality is surgical resection with wide margins, but its rate of recurrence and metastasis is still high. Early detection and complete excision of the tumor is necessary. A MFH of the occipital developed in a 51-year-old woman eight years after surgery and radiation for medulloblastoma of the cerebellar vermis. The secondary neoplasm arose at the site of tumor resection within the irradiated field, and was resected. The development of sarcomas is a recognized complication of radiation therapy. The final diagnosis after the operation was MFH. Radiation-induced sarcoma (RIS) is well known, but radiation-induced MFH is relatively rare in the head and neck region, especially in the occipital. The imaging findings are not diagnosis specific, but strict follow-up within the radiation field by computerized tomography (CT) and magnetic resonance imaging (MRI) and appreciation of the expected latency period may help in providing the diagnosis of RIS.
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Affiliation(s)
| | | | | | | | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantan Xili 6, Chongwen District, Beijing 100050, PR China.
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Majumdar K, Mandal S, Thakkar R, Saran RK, Srivastava AK. Meningeal osteochondroma simulating meningioma with metaplastic change: a rare golf-ball-like lesion of non-meningothelial mesenchymal origin. Brain Tumor Pathol 2013; 31:62-7. [PMID: 23456087 DOI: 10.1007/s10014-013-0138-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 02/12/2013] [Indexed: 11/27/2022]
Abstract
Non-meningothelial mesenchymal tumors of the central nervous system (CNS), including those originating from the meninges, histologically correspond to tumors of soft tissue or bone. These individual entities arising from the meninges are rare, and probably have their origin in the multipotent primitive mesenchymal stem cells of the dura. Though it is a common bone tumor, the meningeal origin of osteochondroma has only very rarely been reported. We describe a case of a 35-year-old female with a well-demarcated, golf-ball-like osteochondroma of meningeal origin which was enucleated en bloc on craniotomy. Such a lesion can resemble a meningioma that exhibits metaplastic (osseous) change on imaging. However, provided that there is clinico-radiological awareness of such tumors, magnetic resonance imaging (MRI) can guide the way to this rare differential diagnosis, as it reflects the pathologic appearance of osteochondroma and allows the thickness of the cartilage cap to be estimated in order to check for rare malignant change. Complete excision along with the cartilage cap usually offers a favorable prognosis without recurrence.
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Affiliation(s)
- Kaushik Majumdar
- G B Pant Hospital, Jawaharlal Nehru Marg, New Delhi, 110002, India
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Majumdar K, Mandal S, Saran RK, Gupta R. Recurrent intracranial myxofibrosarcoma presenting as an extensive fronto-parieto-occipital SOL: An unusual sarcoma of meningeal origin. Clin Neurol Neurosurg 2013; 115:354-8. [DOI: 10.1016/j.clineuro.2012.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 05/25/2012] [Accepted: 05/26/2012] [Indexed: 11/16/2022]
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Yoo RE, Choi SH, Park SH, Jung HW, Kim JH, Sohn CH, Chang KH. Primary Intracerebral Malignant Fibrous Histiocytoma: CT, MRI, and PET-CT Findings. J Neuroimaging 2011; 23:141-4. [DOI: 10.1111/j.1552-6569.2011.00590.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Schmitt WR, Carlson ML, Giannini C, Driscoll CLW, Link MJ. Radiation-Induced Sarcoma in a Large Vestibular Schwannoma Following Stereotactic Radiosurgery: Case Report. Neurosurgery 2011; 68:E840-6; discussion E846. [DOI: 10.1227/neu.0b013e31820780b1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AbstractBACKGROUND AND IMPORTANCE:Stereotactic radiosurgery (SRS) has been employed with increasing frequency in the treatment of benign intracranial tumors. While the risk for radiation-induced malignancy has been well studied for fractionated external beam radiation, reports of SRS-associated malignancy have only begun to emerge over the past 10 years.CLINICAL PRESENTATION:We present a case of a rapidly enlarging, presumed sporadic vestibular schwannoma in a 51-year-old man treated with SRS. Serial imaging over the next 7.5 years demonstrated good radiographic response with consistent involution of the tumor. The patient then developed rapid neurologic deterioration and sustained tumor growth on follow-up imaging. The tumor was resected via a translabyrinthine approach, and pathologic analysis demonstrated undifferentiated high-grade pleomorphic sarcoma (UHGPS).CONCLUSION:This is the first report of undifferentiated high-grade pleomorphic sarcoma (formerly called malignant fibrous histiocytoma) following SRS. This case demonstrates the difficulty of establishing malignant degeneration of a neoplasm following SRS without pretreatment tissue diagnosis. Patients with presumed benign tumors should be counseled about the rare risk of malignant transformation prior to undertaking SRS.
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Affiliation(s)
- William R Schmitt
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Matthew L Carlson
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Caterina Giannini
- Department of Laboratory Medicine and Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Colin LW Driscoll
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Michael J Link
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Pakasa NM, Pasquier B, Chambonnière ML, Morrison AL, Khaddage A, Perret AG, Dumollard JM, Barral FG, Péoc'h M. Atypical presentations of solitary fibrous tumors of the central nervous system: an analysis of unusual clinicopathological and outcome patterns in three new cases with a review of the literature. Virchows Arch 2005; 447:81-6. [PMID: 15926073 DOI: 10.1007/s00428-005-1220-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Accepted: 01/28/2005] [Indexed: 10/25/2022]
Abstract
Central nervous system (CNS) solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms recognized less than a decade ago. Approximately 60 cases of SFT have been reported in the central nervous system. We describe three atypical SFTs of the CNS, two intracranial and one within the spine. One intracranial SFT arose from the sella turcica and expanded into the suprasellar areas. It relapsed twice during the 3 years following partial resection, and the MiB 1 labeling index steadily increased without obvious malignant transformation. The second SFT arose from the confluence of the sinuses, widely invaded the lateral sinus and adjacent bones, had a low MiB 1 index and has not recurred after 5 years. The intraspinal tumor occurred at T5-T7 in a patient with multiple café-au-lait spots, was predominantly myxoid and developed a second similar lesion at S3-S5 14 years later. The MiB 1 index was lower in the second tumor. Immunohistochemistry confirmed that all were SFTs. These atypical presentations gave us an opportunity to provide further information about the natural histological course of CNS SFTs.
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Affiliation(s)
- Nestor M Pakasa
- Department of Pathology, Centre Hospitalier Universitaire de Saint-Etienne, Saint Etienne, France
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