Document Type : Case Reports
Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
Clinical Research Unit, Shahid Bahonar Academic Center, Kerman University of Medical Sciences, Kerman, Iran
A heterogeneous group of CNS tumors are characterized by mixed neuroepithelial and mesenchymal features. Glial tumors manifesting this phenomenon are referred to as gliosarcoma. These tumors are usually mistaken for cerebral metastases or meningioma at operation. Their histological studies have revealed an admixture of gliomatous and sarcomatous tissues, which leads to a biphasic pattern. The mesenchymal component can present in different forms such as fibrosarcoma, undifferentiated pleomorphic sarcoma, chondro-osteogenic, and myogenic differentiation, as well as angiosarcomatous and liposarcomatous types. Squamous differentiation, adenoid formations and glandular structures may also be displayed.
Herein, we report a rare case who was admitted to the emergency room with decreased consciousness resembling methadone poisoning. Clinical work-up showed a temporoparietal mass on radiological investigation. Histopathological evaluation of the brain mass revealed a gliosarcoma with adenoid formations and a mesenchymal component, which manifested as chondrosarcomatous differentiation. Immunohistochemical studies confirmed the histologic diagnosis through positivity for EMA, GFAP, S100, and vimentin expression in different components.
- Rosai J. Rosai and Ackerman's surgical pathology e-book. Elsevier Health Sciences; 2011 Jun 20.
- Kleihues P, Cavenee WK, editors. Pathology and genetics of tumours of the nervous system. Int Agency Res Cancer; 2000.
- Stroebe H. Ueber Entstehung und Bau der Gehirnglioma. Beitr Pathol Anat Allg Pathol. 1895; 19:405-486
- Louis DN. Ohga i H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114:97-109. [DOI:10.1007/s00401-007-0243-4] [PMID] [PMCID]
- Miller CR, Perry A. Glioblastoma: morphologic and molecular genetic diversity. Arch. Path. Lab. Med. 2007 Mar;131(3):397-406.
- Han SJ, Yang I, Tihan T, Prados MD, Parsa AT. Primary gliosarcoma: key clinical and pathologic distinctions from glioblastoma with implications as a unique oncologic entity. J. Neuro-Oncol. 2010 Feb 1;96(3):313-20. [DOI:10.1007/s11060-009-9973-6] [PMID] [PMCID]
- Dunham C. Gliosarcoma-Clinico-pathology, Genetics and a Review of Rare Congenital Cases. Journal-Gliosarcoma-Clinico-pathology, Genetics and a Review of Rare Congenital Cases. 2009. [DOI:10.17925/EOH.2009.05.1.20]
- IH F, SW G. Sarcoma arising in glioblastoma of the brain. Am J Pathol. 1955 Jul 1;31(4):633-53.
- Actor B, Cobbers JL, Büschges R, Wolter M, Knobbe CB, Reifenberger G, Weber RG. Comprehensive analysis of genomic alterations in gliosarcoma and its two tissue components. GENE CHROMOSOME CANC. 2002 Aug;34(4):416-27. [DOI:10.1002/gcc.10087] [PMID]
- Reis RM, Könü-Lebleblicioglu D, Lopes JM, Kleihues P, Ohgaki H. Genetic profile of gliosarcomas. The American journal of pathology. 2000 Feb 1; 156(2):425-32. [DOI:10.1016/S0002-9440(10)64746-3]
- Boerman RH, Anderl K, Herath J, Borell T, Johnson N, Schaeffer-Klein J, Kirchhof A, Raap AK, Scheithauer BW, Jenkins RB. The glial and mesenchymal elements of gliosarcomas share similar genetic alterations. J NEUROPATH EXP NEUR. 1996 Sep 1;55(9):973-81. [DOI:10.1097/00005072-199609000-00004] [PMID]
- Vlodavsky E, Konstantinesku M, Soustiel JF. Gliosarcoma with liposarcomatous differentiation: the new member of the lipid-containing brain tumors family. Arch Pathol Lab Med. 2006 Mar;130(3):381-4.
- Rajeshwari B, Salapathi Shanmugam, Sadiya Niamath, Mitra Ghosh, Siddartha Ghosh. Gliosarcoma with Chondrosarcomatous Differentiation: A Case Report. Ann Lab Med , Vol. 6, Issue 2, February, 2019: C-5-C-8 [DOI:10.21276/APALM.2309]
- Rodriguez FJ, Scheithauer BW, Giannini C, Bryant SC, Jenkins RB. Epithelial and pseudoepithelial differentiation in glioblastoma and gliosarcoma: a comparative morphologic and molecular genetic study. Cancer. 2008 Nov 15;113(10):2779-89. [DOI:10.1002/cncr.23899] [PMID] [PMCID]
- Ozolek JA, Finkelstein SD, Couce ME. Gliosarcoma with epithelial differentiation: immunohistochemical and molecular characterization. A case report and review of the literature. Mod Pathol. 2004 Jun;17(6):739-45. [DOI:10.1038/modpathol.3800109] [PMID]
- Shweikeh F, Drazin D, Bannykh SI. Malignant intracerebral nerve sheath tumors: A case report with review of the literature. Case Rep Surg. 2013 Sep 26;2013. [DOI:10.1155/2013/384076] [PMID] [PMCID]