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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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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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Primary Gliosarcoma of the Cerebellum in a Young Pregnant Woman: Management Challenges and Immunohistochemical Features. Case Rep Surg 2019; 2019:7105361. [PMID: 31396432 PMCID: PMC6664503 DOI: 10.1155/2019/7105361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Gliosarcoma (GS) represents a rare, high-grade (WHO Grade IV), central nervous system neoplasm, characterized by a very poor prognosis. Similar to other high-grade gliomas, GS affects mainly adults in the 5th-7th decade of life and presents a higher incidence in males. The most reported locations of GS are the temporal lobe and the frontal lobe, while only eight cases of GS originating from the posterior cranial fossa are reported in the literature. Case Description We report the first case occurring during pregnancy in a 33-year-old patient. Diagnosis was obtained on the 15th week of gestation when patient presented with signs and symptoms of life-threatening raised intracranial pressure. Surgical excision was followed by early recurrence and eventually disease progression because the patient refused adjuvant treatment to save her fetus. Conclusions GS should be considered in the differential diagnosis of posterior cranial fossa tumors with radiological features of meningioma or glioblastoma, even in young patients. To this regard, sarcomas, solitary fibrous tumors, and even metastases should be considered, especially in light of the tendency of GS to give rise to extracranial localizations. Whenever an aggressive management with radical excision and adjuvant treatment is not safely achievable, disease progression is likely to be unavoidable.
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Lyndon D, Lansley JA, Evanson J, Krishnan AS. Dural masses: meningiomas and their mimics. Insights Imaging 2019; 10:11. [PMID: 30725238 PMCID: PMC6365311 DOI: 10.1186/s13244-019-0697-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 01/15/2019] [Indexed: 02/08/2023] Open
Abstract
Meningiomas are the most common dural tumour. They are regularly being seen as an incidental finding on brain imaging and treated conservatively. However, there are many other dural masses which mimic their appearances, including primary neoplastic processes, metastases, granulomatous diseases and infection. While some of these are rare, others such as metastases and tuberculosis arise relatively frequently in practice. Although not pathognomonic, key features which increase the probability of a lesion being a meningioma include intralesional calcifications, skull hyperostosis, local dural enhancement and increased perfusion. It is important to have an awareness of these entities as well as their main imaging findings, as they have a wide range of prognoses and differing management strategies. This review outlines several of the most important mimics along with their imaging findings on both standard and advanced techniques with key features which may be used to help differentiate them from meningiomas.
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Affiliation(s)
- Daniel Lyndon
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK.
| | - Joseph A Lansley
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK
| | - Jane Evanson
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK
| | - Anant S Krishnan
- Department of Neuroradiology, St Bartholomew's and the Royal London Hospitals, Whitechapel, London, E1 1BB, UK
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Peckham ME, Osborn AG, Palmer CA, Tsai A, Salzman KL. Gliosarcoma: Neuroimaging and Immunohistochemical Findings. J Neuroimaging 2018; 29:126-132. [DOI: 10.1111/jon.12565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Miriam E. Peckham
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Anne G. Osborn
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Cheryl A. Palmer
- Department of Pathology; University of Utah Health Sciences Center; Salt Lake City UT
| | - Amy Tsai
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
| | - Karen L. Salzman
- Department of Radiology and Imaging Sciences; University of Utah Health Sciences Center; Salt Lake City UT
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Zúñiga-Cerón LF, Saavedra-Torres JS, Zamora-Bastidas TO, Pinzón-Fernández MV. Gliosarcoma in a young patient with neurofibromatosis type 1. Case report. CASE REPORTS 2018. [DOI: 10.15446/cr.v4n2.68234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
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.
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Yoon GY, Oh HJ, Oh JS, Yoon SM, Bae HG. Gliosarcoma of Cerebello-Pontine Angle: A Case Report and Review of the Literature. Brain Tumor Res Treat 2018; 6:78-81. [PMID: 30381921 PMCID: PMC6212687 DOI: 10.14791/btrt.2018.6.e11] [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: 06/12/2018] [Revised: 08/18/2018] [Accepted: 08/31/2018] [Indexed: 11/20/2022] Open
Abstract
Gliosarcoma (GS), known as variant of glioblastoma multiforme, is aggressive and very rare primary central nervous system malignant neoplasm. They are usually located in the supratentorial area with possible direct dural invasion or only reactive dural thickening. However, in this case, GS was located in lateral side of left posterior cranial fossa. A 78-year-old man was admitted to our hospital with 3 month history of continuous dizziness and gait disturbance without past medical history. A gadolinium-enhanced MRI demonstrated 5.6×4.8×3.2 cm sized mass lesion in left posterior cranial fossa, heterogeneously enhanced. The patient underwent left retrosigmoid craniotomy with navigation system. The tumor was combined with 2 components, whitish firm mass and gray colored soft & suckable mass. On pathologic report, the final diagnosis was GS of WHO grade IV. In spite of successful gross total resection of tumor, we were no longer able to treat because of the patient's rejection of adjuvant treatment. The patient survived for nine months without receiving any special treatment from the hospital.
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Affiliation(s)
- Gi-Yong Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyuk-Jin Oh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Sang Oh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seok-Mann Yoon
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hack-Gun Bae
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Azami MA, Alami IE, Bourhafour I, Belhabib S, Oukabli M, Albouzidi A. [Primary cerebral gliosarcoma: about two cases and review of the literature]. Pan Afr Med J 2017; 27:14. [PMID: 28904651 PMCID: PMC5534136 DOI: 10.11604/pamj.2017.27.14.8977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/18/2016] [Indexed: 11/11/2022] Open
Abstract
Gliosarcoma is a very rare brain tumor accounting for 1.8 -8% of all glial tumors. It has been classified by the World Health Organization as a variant of glioblastoma. It is a tumor with double glial and sarcomatous component. Patient's clinical picture is polymorphic, imaging data are evocative, diagnosis is based on histology. Treatment is always surgical. Prognosis is closely linked to the quality of resection. We here report two clinical cases with the aim of assessing the diagnostic, therapeutic and prognostic features of this rare entity.
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Affiliation(s)
- Mohamed Amine Azami
- Service d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc
| | - Iliass El Alami
- Service d'Oncologie Médicale, Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc
| | - Imane Bourhafour
- Service de Radiothérapie, Institut National d'Oncologie, Rabat, Maroc
| | - Salwa Belhabib
- Service d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc
| | - Mohamed Oukabli
- Service d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc
| | - Abderrahmane Albouzidi
- Service d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohamed V de Rabat, Maroc
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Duan H, Kitazawa K, Yako T, Ichinose S, Kobayashi S, Sudo M. Gliosarcoma in the Cerebellopontine Angle with Rapid Tumor Growth and Intratumoral Hemorrhage. World Neurosurg 2016; 92:580.e17-580.e21. [PMID: 27338213 DOI: 10.1016/j.wneu.2016.06.053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 06/11/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gliosarcoma is a relatively rare and bimorphous brain tumor, predominantly located in the brain lobe. Here, we report a rare case of gliosarcoma presenting radiologically in the cerebellopontine angle (CPA) region. CASE DESCRIPTION The patient was a 71-year-old woman with progressive tinnitus. A series of image examinations showed a rapidly growing CPA tumor, which enlarged from nonexistent to 4 cm in diameter with extension to the internal auditory canal in a short period of 6 months. The patient was operated on in emergency because of intratumoral hemorrhage and rapidly deteriorating neurologic symptoms. Under the diagnosis of gliosarcoma confirmed by pathologic examination, chemotherapy and radiotherapy were conducted after partial resection. The patient recovered uneventfully and the residual tumor disappeared nearly completely on the image taken 6 months later. CONCLUSIONS Although rare, gliosarcoma should be considered in the differential diagnosis of CPA tumors, especially if it is associated with rapid tumor growth or intratumoral hemorrhage.
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Affiliation(s)
- Hongzhou Duan
- Stroke and Brain Center, Aizawa Hospital, Honjo 2-5-1, Matsumoto, Japan; Department of Neurosurgery, Peking University First Hospital, Xicheng District, Beijing, China.
| | - Kazuo Kitazawa
- Stroke and Brain Center, Aizawa Hospital, Honjo 2-5-1, Matsumoto, Japan
| | - Takehiro Yako
- Stroke and Brain Center, Aizawa Hospital, Honjo 2-5-1, Matsumoto, Japan
| | - Shunsuke Ichinose
- Stroke and Brain Center, Aizawa Hospital, Honjo 2-5-1, Matsumoto, Japan
| | | | - Motohiro Sudo
- Department of Anatomic Pathology, Aizawa Hospital, Honjo 2-5-1, Matsumoto, Japan
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Primary Cerebellar Gliosarcoma with Extracranial Metastases: An Orphan Differential Diagnosis. World Neurosurg 2015; 84:2076.e13-7. [PMID: 26239018 DOI: 10.1016/j.wneu.2015.07.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/18/2015] [Accepted: 07/20/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Gliosarcomas are rare, malignant primary brain tumors, most commonly located in the temporal lobe, that contain both glial and mesenchymal elements. Gliosarcomas located within the cerebellum are exceedingly rare. The previously unreported finding of a cerebellar gliosarcoma concurrently with an extracranial metastasis to the lungs is discussed here. CASE DESCRIPTION A 57-year-old man presented with a 3-month history of chest pain, weight loss, headaches, and vomiting. Physical examination revealed a left cerebellar dysfunction, and the radiological work-up revealed a 6 × 6-cm right apical pulmonary tumor and a 4 × 3.5 × 3.8-cm peripherally enhancing left cerebellar mass. On the basis of a smoking history in the setting of a lung lesion and cerebellar mass, the presumptive diagnosis was primary lung cancer with metastasis to the cerebellum. Gross total resection of a firm pseudo-encapsulated cerebellar mass was performed. The microscopic features and the immunohistochemical profile confirmed the diagnosis of Gliosarcoma. The thoracic lesion was removed subsequently, and pathology confirmed it as an extracranial metastasis from the cerebellar gliosarcoma. Adjuvant radiation and chemotherapy were then administered. No clinical or radiographic evidence of recurrence was observed during one year of follow-up monitoring. CONCLUSIONS To the best of our knowledge, a primary infratentorial gliosarcoma with extracranial metastases has not been previously described.
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Romero-Rojas AE, Diaz-Perez JA, Ariza-Serrano LM, Amaro D, Lozano-Castillo A. Primary gliosarcoma of the brain: radiologic and histopathologic features. Neuroradiol J 2013; 26:639-48. [PMID: 24355182 DOI: 10.1177/197140091302600606] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 11/25/2013] [Indexed: 11/16/2022] Open
Abstract
Gliosarcoma is a rare central nervous system (CNS) neoplasm with biphasic glial and non-glial malignant components. Here we describe the radiologic and histopathologic features observed in five cases of primary gliosarcoma. The mean age at diagnosis in the studied patients was 54.2 years; these patients were predominantly males (male:female ratio = 4:1). At diagnosis all patients had several clinical deterioration. The most common symptoms of presentation were: headache (5/5 cases), seizures (4/5 cases) and hemiparesis (1/5 cases). All the tumors were large (mean major diameter= 4.12±1.64 cm) at diagnosis as evidenced in computer tomography (CT) scans and magnetic resonance images (MRIs), with preferential involvement of the temporal lobe and frequent associated deviation of the midline structures. Other common characteristics identified on CT scans and MRIs were partial contrast medium uptake with annular pattern (5/5 cases), peripheral edema (5/5 cases), and central calcification (3/5 cases). In additional a peak of dye uptake was observed (4/5 cases) on MRI spectrometry. In the histopathology, the glial component showed malignant astrocytes, with high Ki67 (>60%) and p53 positivity; the sarcomatous components displayed pleomorphic spindle cells similarly with p53 positivity and high Ki67 (75-90%) in all cases. Dedifferentiation to pleomorphic sarcoma (two cases), fibrosarcoma (one case), leiomyosarcoma (one case) and MPNST (one case) were documented. All patients received radiotherapy/chemotherapy and had a median overall survival of ten months. The study of radiologic and histopathologic features in primary gliosarcomas of the brain is a priority to achieve early diagnosis that can be translated to better outcomes. Here we describe the radiologic and histopathologic features observed in a group of gliosarcoma patients with variable histopathologic dedifferentiation.
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Computed tomography and magnetic resonance features of gliosarcoma: a study of 54 cases. J Comput Assist Tomogr 2012; 35:667-73. [PMID: 22082533 DOI: 10.1097/rct.0b013e3182331128] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the features of pathologically confirmed gliosarcomas using computed tomography (CT) and magnetic resonance (MR) imaging. METHODS We retrospectively reviewed the cross-sectional CT and MR images of 54 patients (37 males and 17 females; mean age, 44.5 years; range, 13-74 years) with gliosarcomas confirmed by histopathology. RESULTS Across all patients, there were 59 lesions. On nonenhanced CT and MR images, tumors were predominantly inhomogeneous. On the postcontrast CT and MR images, 50 (84.7%) irregular lesions had thick walls with a strong rim- and ringlike enhancement, whereas the remaining 9 (15.3%) round or oval lesions had even thin walls with an enhanced peripheral ring. Magnetic resonance spectroscopy showed increased choline and lactate values, along with decreased N-acetylaspartate and creatine values. On diffusion-weighted imaging, the tumor was slightly or markedly hyperintense compared with the white matter. CONCLUSION A well-demarcated mass located peripherally, with rimlike or ring enhancement, is a common presentation of gliosarcoma on CT and MR images. In addition, magnetic resonance spectroscopy and diffusion-weighted imaging can be used to make a differential diagnosis.
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