1/39. October 1998--61 year old male with brain tumor and oral, lung, and palpebral masses. In Jan. 97 a gliosarcoma was diagnosed in a 61-year- old man after a 6-month history with neurological deficits. A total physical examination, laboratory tests, chest x-ray and abdominal ultrasound scanning revealed no gross abnormalities. Surgery was followed by brain radiation therapy and 6 months later there were metastases to the oral cavity, right palpebra and both lungs. The histological findings of the oral and palpebral metastases revealed only the sarcomatous component. We are aware of 15 cases of gliosarcoma with extraneural metastases, and in 4 of these, the metastases contained only the sarcomatous component. We believe that our case represents the fifth case of pure sarcomatous metastases. ( info) |
2/39. gliosarcoma with angiosarcomatous features: a case report. A surgical case of gliosarcoma in which the mesenchymal component showed angiosarcomatous features is reported. The neoplasm was extirpated from the right cerebral hemisphere of a 76-year-old man who presented with left hemiparesis and headache, and it was composed of both anaplastic astrocytomatous and sarcomatous elements. The sarcomatous element was composed of a proliferation of atypical endothelial cells that had pleomorphic, mitotically active nuclei and formed vascular lumina of irregular shapes or solid cellular sheets, and was accompanied by the deposition of collagenous matrix. The cytoplasm of some of the atypical endothelial cells was immunohistochemically positive for vimentin, factor viii-related antigen, CD 34, and thrombomodulin. The MIB-1 labeling index of the sarcomatous component was higher than that of the astrocytomatous component. ( info) |
3/39. gliosarcoma: a case with unusual epithelial feature. Astrocytic tumors, particularly gliosarcoma, may contain epithelial features in the form of trabecular, adenoid, papillary arrangement, and squamous metaplasia. A case of gliosarcoma with unusual epithelial feature is described. The patient was a 60-year-old male with frequent seizures. The mass was 4 cm and in the left frontal lobe. Trabecular or rarely adenoid arrangement of neoplastic astrocytes was present in the mucinous stroma, and there was a distinctive transition between the trabecular area and typical anaplastic astrocytoma. The tumor cells in the trabecular area showed positive immunostain for glial fibrillary acidic protein, but did not react with various kinds of cytokeratin. The sarcomatous area was undifferentiated and was not labeled by factor-VIII, desmin, and anti-smooth muscle actin. Occurrence and histogenesis of epithelial features in gliosarcoma are reviewed. The importance to recognize the existence of epithelial feature in malignant astrocytic tumor is emphasized. ( info) |
4/39. Histologically repeatedly confirmed gliosarcoma with long survival: review of the literature and report of a case. OBJECTIVE AND IMPORTANCE: A rare case of gliosarcoma in a 61-year-old woman is presented with a stable situation over 22 years with an excellent quality of life. CLINICAL PRESENTATION: The patient was initially symptomatic and was operated on in 1975 for a deep-seated left parietal gliosarcoma. During the following 20 years, she was clinically asymptomatic until she complained of increasing headache in 1995. Neuroradiological imaging showed a sharply demarcated lesion on MRI at the former operative site, which was operated on again. Four months later, the residual tumour did grow again. INTERVENTION: As radiation therapy could not stop tumour progression and the neurological status worsened, the patient was operated on again for a massive tumour mass in the left parieto-occipital region, filling out nearly all of the previous resection cavity. Despite radio-immunotherapy, the patient finally died 22 years after the first discovery of the tumour. CONCLUSION: The present case shows that, in rare instances, gliosarcomas may show prolonged survival, although the underlying pathogenetic mechanisms for this clinical behaviour are not understood. ( info) |
| thallium-201 (201Tl) chloride scintigraphy is the imaging method use for the detection of various tumors including glioblastoma, but only limited information on 201Tl uptake in gliosarcoma is available. We investigated a patient with gliosarcoma by means of 201Tl single-photon emission computed tomography (SPECT) and MRI. SPECT imaging revealed high 201Tl uptake in the tumor, which was closely correlated with contrast-enhancement on MRI. These results suggest that SPECT with 201Tl may be useful for detecting gliosarcoma and provide physiological information on this tumor. ( info) |
6/39. gliosarcoma associated with a huge cyst--case report. A 55-year-old female presented with a unique case of gliosarcoma with a huge cystic component manifesting as loss of consciousness, left-sided hemiparesis, and anisocoria. Computed tomography demonstrated a large cyst in the right frontal lobe, and enhancement of the mural nodule after administration of contrast medium. Emergent operation was performed. Xanthochromic fluid was aspirated, and the tumor was resected. The histological diagnosis was gliosarcoma based on the presence of gliomatous and sarcomatous components. She underwent a second operation because of tumor regrowth 3 weeks after the first operation. The postoperative course was satisfactory during radiation therapy with 60 Gy and chemotherapy. The diagnosis of gliosarcoma was difficult to make preoperatively because of the neuroradiological findings similar to low-grade gliomas. gliosarcoma should be included in the differential diagnosis of huge cystic tumors. ( info) |
| BACKGROUND: We describe a case of an intramedullary metastasis to the cervical spinal cord from a temporal gliosarcoma. CASE DESCRIPTION: A 48-year-old man with known temporal lobe gliosarcoma presented with a new onset of ipsilateral hemiparesis. A MRI scan revealed the presence of an intramedullary lesion in the spinal cord behind the body of C2. Despite repeated craniotomy, radiation, and chemotherapy, the patient succumbed to a rapidly progressive disease. CONCLUSION: The case illustrates the ability of gliosarcoma to metastasize to other locations in the neuroaxis. We believe this to be the first case report of an intramedullary spinal cord metastasis from a gliosarcoma. The pathological features and available literature are reviewed. ( info) |
8/39. Postradiation gliosarcoma with osteosarcomatous components. A 49-year-old man developed a gliosarcoma with prominent osteoid components 15 months after surgical resection and postoperative radiation and chemotherapy for a right frontal glioblastoma multiforme. The recurrent tumor was distinguished from the original lesion by the presence of dense ossification, visible on CT, at the original tumor site. The relevant literature is reviewed. ( info) |
9/39. gliosarcoma with areas of primitive neuroepithelial differentiation and extracranial metastasis. We report a case of gliosarcoma with areas of primitive neuroepithelial differentiation arising in the temporal lobe of a 53-year-old man. The sarcomatous component of this tumor was perivascular in its distribution and showed expression of factor viii-related antigen, smooth muscle actin and CD34. The primitive neuroepithelial component possessed a small cell morphology and showed expression of neuronal antigens. Strong expression of p53 was demonstrated throughout the tumor with only focal weak expression of epidermal growth factor receptor. The tumor developed widespread extraneural metastases 5 months after surgical resection of the primary tumor. Histological examination of the liver metastases showed them to consist predominantly of the primitive neuroepithelial component. We believe this to be a novel pattern of differentiation in a gliosarcoma which in this case was associated with an aggressive metastatic potential. ( info) |
10/39. A lateral ventricular gliosarcoma arising in an ependymoma. OBJECTIVE: We describe a 29-year-old man with gliosarcoma in the lateral ventricle. CASE: The patient presented with headache and impairment of consciousness. Computed tomography and magnetic resonance imaging localized the tumor to the right lateral ventricle and showed heterogeneous enhancement with administration of contrast agents. The tumor was partially removed via a transcallosal approach. Histologic examination disclosed gliosarcoma arising by malignant transformation of an ependymoma. POST-OPERATIVE COURSE: The patient died of tumor progression 78 days after admission, despite intensive radiotherapy and chemotherapy. ( info) |