Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
JUNE 2012
Next Case of the Month coming July 2...
Gliosarcoma
- A rare tumor, a glioblastoma variant (2% of glioblastomas) characterized by a biphasic tissue pattern displaying areas of glial and mesenchymal differentiation.
- WHO Grade IV tumor. Age group: 4th to 6th decade. M > F.
- Location: Cerebral hemispheres (temporal > frontal > parietal > occipital). Rarely, involves the posterior fossa and spinal cord.
- Pr features: Non-specific including vomiting, headaches, and focal neurological deficits.
- Predisposing factors: Prior radiation therapy
- Gliosarcoma has masqueraded as ischemic stroke in at least 3 prior case reports (Mesfin, Preul, Züchner). One such case described invasion of the wall of a major intracranial blood vessel by gliomatous tumor cells on histopathology (Züchner et al). Could such an event have occurred in the current case, leading to infarction first and then subsequent growth of the tumor? We do not know. Another remote but plausible hypothesis is the association of PTEN mutation with both gliosarcoma and infarction. For a further detailed and a very interesting discussion, please refer to the audio file.
- Key Diagnostic Features: Predominant sarcomatous component: Hyperdense mass on CT, hypointense on T2WI, demonstrating diffusion restriction and homogeneous enhancement. Predominant gliomatous component: features are similar to glioblastoma.
- Rx: Surgery with postoperative chemotherapy and radiation therapy.
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