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Li C, Zhou W, Wang P, Ji P, Wang Y, Guo S, Zhai Y, Xu M, Wang L, Feng F, Liu J. Prognostic Factors for Patients with Primary Gliosarcoma: A Single-Center Retrospective Study. World Neurosurg 2024:S1878-8750(24)01497-9. [PMID: 39216722 DOI: 10.1016/j.wneu.2024.08.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/23/2024] [Accepted: 08/24/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Primary gliosarcoma is a rare form of malignant central nervous system tumor, with limited understanding regarding its prognostic determinants and effective therapeutic interventions. METHODS The medical records of patients diagnosed with gliosarcoma at Tangdu Hospital between March 2011 and June 2023 were retrospectively analyzed in this study. Patients with a prior history of glioma or those who received preoperative chemoradiotherapy were excluded. Survival analyses were conducted using Kaplan-Meier and Cox regression analysis. RESULTS A total of 77 patients were included in the final analysis, with a median age of 57 years (range: 13-83). The predominant symptom leading to diagnosis was headache, and the temporal lobe was the most frequently affected site. Univariate analysis revealed that age ≤65 years, complete resection, Ki67 ≤ 25%, postoperative Karnofsky Performance Status ≥ 70, adherence to the Stupp protocol, and additional active therapy upon relapse were associated with enhanced survival. Furthermore, multivariate analysis identified complete resection, age ≤65 years, Stupp protocol treatment, and active therapy following relapse were independent predictors of overall survival. Notably, 1 patient experienced subcutaneous metastasis during treatment. CONCLUSIONS The present study's findings suggest that optimal management of primary gliosarcoma entails maximal safe resection, combined with adjuvant radiotherapy and chemotherapy with temozolomide, followed by salvage therapy in case of recurrence. However, the risk of metastases should be carefully monitored during the treatment course.
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Affiliation(s)
- Chen Li
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Wenqian Zhou
- The Fourth Student Brigade of Basic Medical College, Air Force Medical University, Xian, China
| | - Peng Wang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peigang Ji
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Yuan Wang
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Shaochun Guo
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Yulong Zhai
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Meng Xu
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liang Wang
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China
| | - Fuqiang Feng
- Department of Neurosurgery, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jinghui Liu
- Department of Neurosurgery, The Second Affiliated Hospita of Air Force Medical University, Xian, China.
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La Torre D, Della Torre A, Lo Turco E, Longo P, Pugliese D, Lacroce P, Raudino G, Romano A, Lavano A, Tomasello F. Primary Intracranial Gliosarcoma: Is It Really a Variant of Glioblastoma? An Update of the Clinical, Radiological, and Biomolecular Characteristics. J Clin Med 2023; 13:83. [PMID: 38202090 PMCID: PMC10779593 DOI: 10.3390/jcm13010083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Gliosarcomas (GS) are sporadic malignant tumors classified as a Glioblastoma (GBM) variant with IDH-wild type phenotype. It appears as a well-circumscribed lesion with a biphasic, glial, and metaplastic mesenchymal component. The current knowledge about GS comes from the limited literature. Furthermore, recent studies describe peculiar characteristics of GS, such as hypothesizing that it could be a clinical-pathological entity different from GBM. Here, we review radiological, biomolecular, and clinical data to describe the peculiar characteristics of PGS, treatment options, and outcomes in light of the most recent literature. A comprehensive literature review of PubMed and Web of Science databases was conducted for articles written in English focused on gliosarcoma until 2023. We include relevant data from a few case series and only a single meta-analysis. Recent evidence describes peculiar characteristics of PGS, suggesting that it might be a specific clinical-pathological entity different from GBM. This review facilitates our understanding of this rare malignant brain tumor. However, in the future we recommend multi-center studies and large-scale metanalyses to clarify the biomolecular pathways of PGS to develop new specific therapeutic protocols, different from conventional GBM therapy in light of the new therapeutic opportunities.
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Affiliation(s)
- Domenico La Torre
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Attilio Della Torre
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Erica Lo Turco
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Prospero Longo
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Dorotea Pugliese
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Paola Lacroce
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Giuseppe Raudino
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Alberto Romano
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
| | - Angelo Lavano
- Department of Medical and Surgery Sciences, School of Medicine, AOU “Renato Dulbecco”, University of Catanzaro, 88100 Catanzaro, Italy; (A.D.T.); (P.L.); (P.L.); (A.L.)
| | - Francesco Tomasello
- Humanitas, Istituto Clinico Catanese, 95045 Catania, Italy; (D.P.); (G.R.); (A.R.); (F.T.)
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Matute-González M, Mosteiro-Cadaval A, Vidal-Robau N, Páez-Carpio A, Valduvieco I, Pineda E, González JJ, Aldecoa I, Oleaga L. Clinicopathological and Neuroimaging Features of Primary Gliosarcoma: A Case Series and Review of Literature. World Neurosurg 2023; 178:e480-e488. [PMID: 37516148 DOI: 10.1016/j.wneu.2023.07.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Gliosarcoma (GS) is a rare primary high-grade brain neoplasm with a poor prognosis and challenging surgical resection. Although it is now considered a morphologic variant of IDH-wildtype glioblastoma (World Health Organization Classification of Tumours 2021), GS may display peculiarities that hamper both surgical and oncological management. METHODS In this retrospective study, we searched our registry for histologically confirmed GS patients between 2006 and 2020. Cases were reviewed for clinical information, pathologic characteristics, imaging findings, management, and outcome. RESULTS 21 patients with histologically confirmed GS were identified with a median age of 62 years. Twelve were men and 9 women. The temporal lobe was the most common location (9 patients, 42.9%). Nineteen patients underwent surgical resection, and only 4 (19%) demonstrated gross total resection on postsurgical MRI, with an overall median survival of 7 months (range, 0.5-37). Diagnostic MRI demonstrated heterogenous lesions with necrotic-cystic areas and a ring-enhancement pattern. Only 1 case of extracranial extension was seen in our sample, and no patient showed distant metastases. CONCLUSIONS The rarity of primary GS and the absence of specific therapeutic guidelines represent a significant clinical challenge. Our study provides a comprehensive analysis of clinical and neuroimaging characteristics in a real-world patient cohort and compares our findings with the available literature.
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Affiliation(s)
- Mario Matute-González
- Department of Neuroradiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
| | | | - Nuria Vidal-Robau
- Department of Pathology, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Páez-Carpio
- Department of Neuroradiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Izaskun Valduvieco
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Estela Pineda
- Department of Oncology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - José Juan González
- Department of Neurosurgery, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Iban Aldecoa
- Department of Pathology, Biomedical Diagnostic Center (CDB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Neurological Tissue Bank of the Biobank-IDIBAPS-FCRB, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Laura Oleaga
- Department of Neuroradiology, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
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4
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Alghamdi KT, Albattah GA, Alnasyan SS, Alhabib AZ, Samkari AMN, Kutub HY. Central nervous system metastasis in a young female patient with primary mediastinal large B-cell lymphoma: A case report and literature review. Surg Neurol Int 2023; 14:270. [PMID: 37560590 PMCID: PMC10408608 DOI: 10.25259/sni_414_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/15/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Primary mediastinal B-cell lymphoma (PMBCL) is a subtype of diffuse large B-cell lymphoma that originates from a B cell in the thymus. It usually affects young female. CASE DESCRIPTION A 30-year-old woman presented with mediastinal mass with history of shortness of breath and chest pain. blood analysis showed low levels of hemoglobin, hematocrit, and mean corpuscular volume and high red cell distribution width. A computed tomography (CT)-guided mediastinal core biopsy disclosed primary mediastinal large B-cell lymphoma (PMLBL) with a nongerminal center phenotype and lung tissue infiltrate. Moreover, after undergoing six cycles of rituximab, cyclophosphamide, hydroxydaunomycin, Oncovin, and prednisone (R-CHOP) chemotherapy and mediastinal radiotherapy, the patient presented with headache and visual disturbance due to multiple supratentorial lesions. CONCLUSION Till date, only a few cases of central nervous system (CNS) metastasis have been reported in the literature. Moreover, CNS metastasis of refractory PMBCL is an uncommon event with a poor prognosis. Brain metastases are often the ultimate fatal consequence of many aggressive cancers, so early detection and treatment are important.
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Affiliation(s)
- Khalid Talal Alghamdi
- Department of Neurosurgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | | - Ali Zaki Alhabib
- College of Medicine, King Abdulaziz University,Jeddah, Saudi Arabia
| | - Alaa Mohammed Noor Samkari
- Department of Pathology, King Abdul-Aziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hussam Yousef Kutub
- Department of Neurosurgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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5
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Alghamdi KT, Ashqar AA, Alamoudi A, Alzahrani A, Samkari A, Kutub H. Gliosarcoma Invading the Temporal Bone, Temporalis Muscle, and Skull Base. Cureus 2023; 15:e42319. [PMID: 37614263 PMCID: PMC10443122 DOI: 10.7759/cureus.42319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/25/2023] Open
Abstract
Gliosarcoma (GS) is a primary central nervous system tumor. It is an unusual type of glioblastoma multiforme (GBM) and rarely invades the skull base. It has a biomorphic tissue pattern with rapid alternation zones of glial and mesenchymal differentiation. We report the case of a 62-year-old male who presented with a one-month history of unsteady gait associated with dizziness. Brain MRI showed a right temporal mass that invaded the skull base with perilesional edema and a significant mass effect on the right lateral ventricle. The patient underwent a right-sided frontotemporal craniotomy with gross total resection. The pathology confirmed the diagnosis of GS. Postoperatively, the patient had an uneventful recovery with no complications and was discharged two days post-surgery.
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Affiliation(s)
- Khalid T Alghamdi
- Neurosurgery, King Faisal Specialist Hospital and Reseach Centre, Riyadh, SAU
| | - Alaa A Ashqar
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ahmad Alamoudi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Abdullah Alzahrani
- General Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Alaa Samkari
- Pathology and Laboratory Medicine, King Abdulalziz Medical City, Jeddah, SAU
| | - Hussam Kutub
- Neurosurgery, King Abdulaziz Medical City, Jeddah, SAU
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Gliosarcoma with extensive extracranial metastatic spread and familial coincidence: A case report. Pathol Res Pract 2023; 244:154399. [PMID: 36905695 DOI: 10.1016/j.prp.2023.154399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
Gliosarcoma is a rare histopathological subtype of glioblastoma. Metastatic spreading is unusual. In this report, we illustrate a case of gliosarcoma with extensive extracranial metastases with confirmation of histological and molecular concordance between the primary tumor and a metastatic lesion of the lung. Only the autopsy revealed the extent of metastatic spread and the hematogenous pattern of metastatic dissemination. Moreover, the case bared a familial coincidence of malignant glial tumors as the patient's son was diagnosed with a high-grade glioma shortly after the patient's death. By molecular analysis (Sanger and next generation panel sequencing), we could confirm that both patient's tumors carried mutations in the TP53 gene. Interestingly, the detected mutations were located in different exons. Altogether, this case draws attention to the fact that sudden clinical aggravation could be caused by the rare phenomenon of metastatic spread and should therefore be always taken into consideration, even at an early disease stage. Furthermore, the presented case highlights the contemporary value of autoptic pathological examination.
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7
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Mirchia K, Mahoney MT, Christie O, Fuller CE, Mirchia K. A Rare Tumor in a Rare Location: Radiology and Pathology Findings With a Literature Review on Intraventricular Gliosarcoma. Cureus 2023; 15:e34622. [PMID: 36891012 PMCID: PMC9987255 DOI: 10.7759/cureus.34622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2023] [Indexed: 02/06/2023] Open
Abstract
Gliosarcoma (GS) is an extraordinarily rare variant of glioblastoma, which is differentiated by its distinct biphasic histopathological morphology consisting of both glial and mesenchymal elements. Although GS has a predilection for the cortical hemispheres, rare occurrences of intraventricular gliosarcoma (IVGS) have been documented in the literature. In this report, we present a 68-year-old female patient with a primary IVGS arising from the frontal horn of the left ventricle with corresponding left ventricular entrapment. The clinical course as well as associated tumor features as observed on computed tomography (CT), magnetic resonance imaging (MRI), and immunohistochemical studies are presented along with a relevant review of the current literature.
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Affiliation(s)
- Kavya Mirchia
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Mary T Mahoney
- College of Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Omari Christie
- Radiology, State University of New York Upstate Medical University, Syracuse, USA
| | - Christine E Fuller
- Pathology, State University of New York Upstate Medical University, Syracuse, USA
| | - Kanish Mirchia
- Pathology, University of California San Francisco, San Francisco, USA
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8
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Liu J, Li C, Wang Y, Ji P, Guo S, Zhai Y, Wang N, Xu M, Wang J, Wang L. Prognostic and predictive factors of secondary gliosarcoma: A single-institution series of 18 cases combined with 89 cases from literature. Front Oncol 2023; 12:1026747. [PMID: 36798692 PMCID: PMC9927223 DOI: 10.3389/fonc.2022.1026747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction Secondary gliosarcomas (SGS) are rare malignancies that are diagnosed subsequent to pre-existing glioma. Clinical features and optimal treatment strategies for SGS have not been conclusively established. This study aimed to assess the clinicopathological features and outcomes of SGS. Methods We assessed the clinicopathological features and outcomes of SGS via retrospective analysis of data for SGS patients at Tangdu Hospital. Data from SGS patients in prior publications were also analyzed in accordance with PRISMA guidelines. Results Eighteen SGS patients who had been treated at Tangdu Hospital between 2013 and 2020 were enrolled in this study. Additional 89 eligible SGS patients were identified from 39 studies. The median age for the patients was 53 years old, and the most common location was the temporal lobe. The most common initial diagnosis was glioblastoma (GBM) (72.0%). Radiology revealed enhanced masses in 94.8% (73/77) of patients. Ten patients (10/107, 9.35%) had extracranial metastases at or after SGS diagnosis. Patients with initial diagnosis of non-GBM and who were younger than 60 years of age were significantly associated with a long duration of disease progression to SGS. After SGS diagnosis, patients with initial non-GBM diagnosis, gross total resection and chemoradiotherapy exhibited prolonged survival outcomes. Patients who had been initially diagnosed with GBM and received both chemoradiotherapy and active therapy after disease progression to SGS, had a significantly longer overall survival than patients who did not. Conclusion Initial diagnosis of GBM was a poor prognostic factor for SGS. Patients who underwent gross total resection and chemoradiation had better overall survival outcomes than those who did not. However, during treatment, clinicians should be cognizant of possible extracranial metastases.
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Affiliation(s)
- Jinghui Liu
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Chen Li
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yuan Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Peigang Ji
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Shaochun Guo
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yulong Zhai
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Na Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China
| | - Meng Xu
- Evidence-Based Social Sciences Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Julei Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China,*Correspondence: Julei Wang, ; Liang Wang,
| | - Liang Wang
- Department of Neurosurgery, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China,Innovation Center for Advanced Medicine, Tangdu Hospital, The Fourth Military Medical University, Xi’an, China,*Correspondence: Julei Wang, ; Liang Wang,
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NAKAGAKI Y, KAI K, KOMOHARA Y, TAKEZAKI T, KURODA J, SHINOJIMA N, SHIMOMURA M, KAWAKAMI F, MIKAMI Y, MUKASA A. Gliosarcoma with Systemic Metastasis Showing Favorable Response to Ifosfamide, Carboplatin, and Etoposide Chemotherapy: An Autopsy Case Report. NMC Case Rep J 2022; 9:263-268. [PMID: 36186622 PMCID: PMC9484818 DOI: 10.2176/jns-nmc.2022-0075] [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: 03/08/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022] Open
Abstract
Gliosarcoma is a rare malignant neoplasm. It accounts for approximately 2% of all glioblastomas. To date, there is no established treatment method for gliosarcoma, and a variety of therapies, such as surgical resection, radiotherapy, and chemotherapy, are typically employed. Here, we describe a patient with gliosarcoma who, despite multiple tumor metastases throughout the body, including the lungs and lymph nodes, achieved a relatively long survival due to salvage therapy with local irradiation and remarkably effective chemotherapy with low-dose ifosfamide, carboplatin, and etoposide therapy. When the patient died, we performed autopsy and confirmed the nature of the primary and metastatic tumor cells that had spread throughout the patient's body. Clinical and systemic histological studies also suggested the possibility of re-metastasis to the brain from systemic metastatic foci. Gliosarcoma appears to have characteristics similar to sarcoma as well as a higher risk of systemic metastasis. Therefore, a careful follow-up is necessary in such patients.
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Affiliation(s)
- Yuki NAKAGAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Keitaro KAI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshihiro KOMOHARA
- Department of Cell Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Tatsuya TAKEZAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Junichiro KURODA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
| | - Naoki SHINOJIMA
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Mari SHIMOMURA
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Fumi KAWAKAMI
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshiki MIKAMI
- Department of Diagnostic Pathology, Graduate School of Medical Sciences, Kumamoto University
| | - Akitake MUKASA
- Department of Neurosurgery, Graduate School of Medical Sciences, Kumamoto University
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10
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Kim YJ, Ahn KH, Lee KH, Moon KS. Case report: Fulminant extraneural metastasis of glioblastoma through venous sinus. Front Oncol 2022; 12:1034944. [PMID: 36338688 PMCID: PMC9633940 DOI: 10.3389/fonc.2022.1034944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background Extraneural metastasis (ENM) of glioblastoma are rare. However, as patient overall survival improves, the incidence of ENM has gradually increased. Although several risk factors have been proposed, venous sinus invasion was regarded as a very exceptional route for ENM. Case description We report a 60-year-old man with glioblastoma in the temporal lobe, invading the transverse and sigmoid venous sinus. After gross total tumor resection, the patient received the standard chemoradiation therapy. Systemic evaluation for persistent shoulder and back pain revealed widespread metastasis to lymph nodes and multiple bones 9 months after surgery. Despite spine radiation therapy, the patient became paraplegic and died 1 year after surgery. Conclusions Venous sinus invasion should be kept in mind by physicians, as a risk factor for glioblastoma ENM. Systemic evaluation of these patients with extracranial symptoms should be performed without hesitation.
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Affiliation(s)
- Yeong Jin Kim
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Jeollanam-do, South Korea
| | - Kang Hee Ahn
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Jeollanam-do, South Korea
| | - Kyung-Hwa Lee
- Department of Pathology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Jeollanam-do, South Korea
- *Correspondence: Kyung-Sub Moon, ; Kyung-Hwa Lee,
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Jeollanam-do, South Korea
- *Correspondence: Kyung-Sub Moon, ; Kyung-Hwa Lee,
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11
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Luo M, Yang J, Sun J, Wang F, Chai X. Primary gliosarcoma with widespread extracranial metastases—spatiotemporal morphological variation. Chin Neurosurg J 2022; 8:20. [PMID: 35932030 PMCID: PMC9354287 DOI: 10.1186/s41016-022-00285-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 06/08/2022] [Indexed: 12/25/2022] Open
Abstract
Abstract
Background
We summarize 5 cases of primary gliosarcoma with widespread extracranial metastases including our case. The glial components are eliminated due to the needs of the living environment in the process of parasitism and survival of brain glioma-sarcoma cells in lung metastasis.
Methods
A PubMed search using the keywords “gliosarcoma” and “extracranial metastases” was performed followed by a review of cited literature. Our case was a 50-year-old female presented with headache and dizziness. MRI examination showed that there was a cystic solid tumor in the right temporal lobe. The tumor was removed totally. Seven months after the operation, the patient suffered recurrent intermittent headache. The resection for the recurrent tumor was performed. Postoperative pathology confirmed the recurrent gliosarcoma. A needle biopsy was performed for the nodular on the right lung. The lung tumor pathology suggested a sarcoma structure.
Results
There was a female patient in five cases. The age range is 47 to 69 years old. The tumor recurred within a year. A combination of treatment modalities may extend survival; however, the prognosis remains poor.
Conclusion
Primary gliosarcoma with extracranial metastases is extremely rare. Some findings uncovered an unexpected spatiotemporal morphological variation in the different foci of the same malignancy.
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12
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Labak CM, Rabah NM, Kipke JP, Mahajan UV, Labak KB, Ali SA, Fowler N, Sloan AE. Multidisciplinary approaches to gliosarcoma: A case report and review of the literature. Clin Case Rep 2022; 10:e5985. [PMID: 36017117 PMCID: PMC9396286 DOI: 10.1002/ccr3.5985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/31/2022] [Accepted: 06/03/2022] [Indexed: 11/30/2022] Open
Abstract
A 58-year-old right-handed man presented to our tertiary care center with gliosarcoma (GS) infiltration through the dura, skull, and soft tissue. Patient had a previous history of right temporal GS, with four intracranial surgeries prior to presentation. A multidisciplinary approach was used to treat the lesion and perform reconstruction.
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Affiliation(s)
- Collin M. Labak
- Department of NeurosurgeryUniversity Hospitals Cleveland Medical Center, Case Western Reserve UniversityClevelandOhioUSA
| | - Nicholas M. Rabah
- Department of NeurosurgeryUniversity Hospitals Cleveland Medical Center, Case Western Reserve UniversityClevelandOhioUSA
| | - Jasmine P. Kipke
- Department of NeurosurgeryUniversity Hospitals Cleveland Medical Center, Case Western Reserve UniversityClevelandOhioUSA
| | - Uma V. Mahajan
- Case Western Reserve University School of MedicineClevelandOhioUSA
| | | | - S. Ahmed Ali
- Department of OtolaryngologyUniversity Hospitals Cleveland Medical Center, Case Western Reserve UniversityClevelandOhioUSA
| | - Nicole Fowler
- Department of OtolaryngologyUniversity Hospitals Cleveland Medical Center, Case Western Reserve UniversityClevelandOhioUSA
- Seidman Cancer Center and Case Comprehensive Cancer CenterClevelandOhioUSA
| | - Andrew E. Sloan
- Department of NeurosurgeryUniversity Hospitals Cleveland Medical Center, Case Western Reserve UniversityClevelandOhioUSA
- Seidman Cancer Center and Case Comprehensive Cancer CenterClevelandOhioUSA
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13
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Bone metastasis from glioblastoma: a systematic review. J Neurooncol 2022; 158:379-392. [PMID: 35578056 DOI: 10.1007/s11060-022-04025-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Glioblastoma (GBM) is a devastating disease with poor overall survival. Despite the common occurrence of GBM among primary brain tumors, metastatic disease is rare. Our goal was to perform a systematic literature review on GBM with osseous metastases and understand the rate of metastasis to the vertebral column as compared to the remainder of the skeleton, and how this histology would fit into our current paradigm of treatment for bone metastases. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant literature search was performed using the PubMed database from 1952 to 2021. Search terms included "GBM", "glioblastoma", "high-grade glioma", "bone metastasis", and "bone metastases". RESULTS Of 659 studies initially identified, 67 articles were included in the current review. From these 67 articles, a total of 92 distinct patient case presentations of metastatic glioblastoma to bone were identified. Of these cases, 58 (63%) involved the vertebral column while the remainder involved lesions within the skull, sternum, rib cage, and appendicular skeleton. CONCLUSION Metastatic dissemination of GBM to bone occurs. While the true incidence is unknown, workup for metastatic disease, especially involving the spinal column, is warranted in symptomatic patients. Lastly, management of patients with GBM vertebral column metastases can follow the International Spine Oncology Consortium two-step multidisciplinary algorithm for the management of spinal metastases.
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14
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Kavouridis VK, Ligon KL, Wen PY, Iorgulescu JB. Survival outcomes associated with MGMT promoter methylation and temozolomide in gliosarcoma patients. J Neurooncol 2022; 158:111-116. [PMID: 35474499 DOI: 10.1007/s11060-022-04016-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Gliosarcoma is an uncommon glioblastoma subtype, for which MGMT promoter methylation's relationship with response to temozolomide chemotherapy is unclear. We therefore examined this question using a national cohort. METHODS The National Cancer Database was queried for patients histopathologically diagnosed with gliosarcoma between 2010 and 2019. The associations between MGMT promoter methylation, first-line single-agent chemotherapy-presumed to be temozolomide herein-and overall survival (OS) were examined using log-rank tests and Cox regression, with correction for multiple testing (p < 0.01 was significant). RESULTS 580 newly-diagnosed gliosarcoma patients with MGMT status were available, among whom 33.6% were MGMT promoter methylated. Median OS for gliosarcoma patients that received standard-of-care temozolomide and radiotherapy was 12.1 months (99% confidence interval [CI] 10.8-15.1) for MGMT promoter unmethylated and 21.4 months (99% CI 15.4-26.2) for MGMT promoter methylated gliosarcomas (p = 0.003). In multivariable analysis of gliosarcoma patients-which included the potential confounders of age, sex, maximal tumor size, extent of resection, and radiotherapy-receipt of temozolomide was associated with improved OS in both MGMT promoter methylated (hazard ratio [HR] 0.23 vs. no temozolomide, 99% CI 0.11-0.47, p < 0.001) and unmethylated (HR 0.50 vs. no temozolomide, 99% CI 0.29-0.89, p = 0.002) gliosarcomas. MGMT promoter methylation was associated with improved OS among temozolomide-treated gliosarcoma patients (p < 0.001), but not in patients who did not receive chemotherapy (p = 0.35). CONCLUSION In a national analysis of gliosarcoma patients, temozolomide was associated with prolonged OS irrespective of MGMT status. These results provide support for the current practice of trimodal therapy for gliosarcoma.
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Affiliation(s)
- Vasileios K Kavouridis
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
| | - Keith L Ligon
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Patrick Y Wen
- Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - J Bryan Iorgulescu
- Department of Neurosurgery, Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA. .,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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15
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Corvino S, Peca C, Corazzelli G, Maiuri F. Gliosarcoma with direct involvement of the oculomotor nerve: Case report and literature review. Radiol Case Rep 2022; 17:1148-1153. [PMID: 35169418 PMCID: PMC8829493 DOI: 10.1016/j.radcr.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/22/2022] Open
Abstract
Gliosarcoma is a rare malignant brain tumor, characterized by a biphasic tissue pattern with alternating areas displaying glial and mesenchymal differentiation. We first report a case of temporo-mesial gliosarcoma, extended to the crural and ambient cisterns, with direct involvement of the ipsilateral third cranial nerve and encasement of anterior choroidal, posterior communicant and posterior cerebral arteries, presenting without symptoms of peripheral neuropathy. A 61-year-old woman with 1-month history of intense bilateral frontal-temporal headache resistant to pharmacological therapy and paresis of the left lower midface underwent surgical resection, through pterional trans-sylvian approach, of a right temporo-mesial gliosarcoma which directly involved the ipsilateral oculomotor nerve. Reported cases of gliomas with direct involvement of a cranial nerve, from the third to the twelfth, are very rare, whit no cases of gliosarcoma described. Because of its rarity, sometimes this entity is not considered as diagnostic hypothesis and is misdiagnosed, both during preoperative diagnostic evaluation and during the surgery. Gliosarcoma is a strong challenge for neurosurgeons and neurooncologists because of low incidence, poor prognosis and limited reported cases on literature. This case shows unique features for localization, pattern of growth and clinical presentation.
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Affiliation(s)
- Sergio Corvino
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic; University “Federico II” of Naples, “Federico II”, 5, Via S. Pansini, Naples 80131, Italy
| | - Carmela Peca
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic; University “Federico II” of Naples, “Federico II”, 5, Via S. Pansini, Naples 80131, Italy
| | - Giuseppe Corazzelli
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic; University “Federico II” of Naples, “Federico II”, 5, Via S. Pansini, Naples 80131, Italy
| | - Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic; University “Federico II” of Naples, “Federico II”, 5, Via S. Pansini, Naples 80131, Italy
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16
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Chen Y, Zhou S, Zhou X, Dai X, Wang L, Chen P, Zhao S, Shi C, Xiao S, Dong J. Gliosarcoma with osteosarcomatous component: A case report and short review illustration. Pathol Res Pract 2022; 232:153837. [DOI: 10.1016/j.prp.2022.153837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/27/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022]
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17
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Amer A, Khose S, Alhasan H, Pokhylevych H, Fuller G, Chasen N, de Groot J, Johnson JM. Clinical and survival characteristics of primary and secondary gliosarcoma patients. Clin Neurol Neurosurg 2022; 214:107146. [DOI: 10.1016/j.clineuro.2022.107146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
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18
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Krishnan AS, Gupta S, Mandal S, Phulware RH, Gupta M. Metachronous Osseous Metastases From Gliobliostoma Mutiforme: An Unusual Presentation. Cureus 2022; 14:e22587. [PMID: 35355536 PMCID: PMC8957711 DOI: 10.7759/cureus.22587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2022] [Indexed: 11/26/2022] Open
Abstract
Metastasis occurs very rarely in glioblastoma cases. Diagnosing metastatic glioblastoma has to follow a strict protocol to avoid misdiagnosis. Weiss’s 1955 criteria, which is in prevalence, needs to be modified to include current standards of investigation. We report an interesting case of metachronous osseous metastasis from a primary glioblastoma with a complete response at a local site. We also suggest modifications to Weiss’ criteria, which may improve its utility in establishing the diagnosis of metastatic glioblastoma.
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19
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Wang X, Jiang J, Liu M, You C. Treatments of gliosarcoma of the brain: a systematic review and meta-analysis. Acta Neurol Belg 2021; 121:1789-1797. [PMID: 33156945 DOI: 10.1007/s13760-020-01533-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023]
Abstract
Gliosarcoma (GSM) is a rare central nervous system tumor. Clinical management of it is similar to glioblastoma (GBM). However, due to a few comparative studies exist, uncertainty and disagreements remain in the literatures. To assess the available evidence on the value of different treatments and to carry out an up-to-date evaluation to summarize the evidence for the optimal treatment in GSM patients. Free words were used to search for the relevant studies without language limitations in electronic databases including PubMed, Ovid EMBASE, Cochrane Central Register of Controlled Trials from inception to September 15, 2019. Pooled hazard ratio (HR) with 95% confidence interval (CI) were calculated using a random-effects model. The main endpoint was all-cause mortality. Overall, 10 studies published between 2008 and 2018 including 803 patients were selected for the meta-analysis. Temozolomide (TMZ)-dominated chemotherapy was associated with a reduced risk of overall survival (OS), with HR 0.49 (95% CI 0.37-0.66). The pooled HR of OS was 0.40 (95% CI 0.29-0.56) between radiotherapy and without radiotherapy. The pooled HR (0.52, 95% CI 0.32-0.85) indicated gross total resection (GTR) had a positive impact on OS in GSM. In patients with GSM, survival benefits as currently performed are associated with TMZ-dominated chemotherapy and high-dose radiotherapy. Our systematic review and meta-analysis also demonstrate GTR is associated with a reduction in all-cause mortality in patients with primary GSM.
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Affiliation(s)
- Xing Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, St. Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiao Jiang
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Changsha, 410008, Hunan, People's Republic of China
| | - Meixi Liu
- Department of Rehabilitation, Huashan Hospital, Fudan University, Shanghai, 200040, People's Republic of China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, St. Guoxuexiang, Chengdu, 610041, Sichuan, People's Republic of China.
- West China Brain Research Centre, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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20
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Li J, Zhao YH, Tian SF, Xu CS, Cai YX, Li K, Cheng YB, Wang ZF, Li ZQ. Genetic alteration and clonal evolution of primary glioblastoma into secondary gliosarcoma. CNS Neurosci Ther 2021; 27:1483-1492. [PMID: 34605602 PMCID: PMC8611784 DOI: 10.1111/cns.13740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
Aims Secondary gliosarcoma (SGS) rarely arises post treatment of primary glioblastoma multiforme (GBM), and contains gliomatous and sarcomatous components. The origin and clonal evolution of SGS sarcomatous components remain uncharacterized. Therapeutic radiation is mutagenic and can induce sarcomas in patients with other tumor phenotypes, but possible causal relationships between radiotherapy and induction of SGS sarcomatous components remain unexplored. Herein, we investigated the clonal origin of SGS in a patient with primary GBM progressing into SGS post‐radiochemotherapy. Methods Somatic mutation profile in GBM and SGS was examined using whole‐genome sequencing and deep‐whole‐exome sequencing. Mutation signatures were characterized to investigate relationships between radiochemotherapy and SGS pathogenesis. Results A mutation cluster containing two founding mutations in tumor‐suppressor genes NF1 (variant allele frequency [VAF]: 50.0% in GBM and 51.1% in SGS) and TP53 (VAF: 26.7% in GBM and 50.8% in SGS) was shared in GBM and SGS. SGS exhibited an overpresented C>A (G>T) transversion (oxidative DNA damage signature) but no signature 11 mutations (alkylating‐agents – exposure signature). Since radiation induces DNA lesions by generating reactive oxygen species, the mutations observed in this case of SGS were likely the result of radiotherapy rather than chemotherapy. Conclusions Secondary gliosarcoma components likely have a monoclonal origin, and the clone possessing mutations in NF1 and TP53 was likely the founding clone in this case of SGS.
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Affiliation(s)
- Jie Li
- Brain Glioma Center, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Physiology, Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Yu-Hang Zhao
- Brain Glioma Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Su-Fang Tian
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Cheng-Shi Xu
- Brain Glioma Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu-Xiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kai Li
- Brain Glioma Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan-Bing Cheng
- Wuhan Frasergen Bioinformatics Company Limited, Wuhan, China
| | - Ze-Fen Wang
- Brain Glioma Center, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of Physiology, Wuhan University School of Basic Medical Sciences, Wuhan, China
| | - Zhi-Qiang Li
- Brain Glioma Center, Zhongnan Hospital of Wuhan University, Wuhan, China
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21
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Kim DW, Moon HC, Kim YG, Dho YS. The role of gamma knife radiosurgery in occurrence of secondary gliosarcoma after treatment of glioblastoma: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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22
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Maurer CJ, Mader I, Joachimski F, Staszewski O, Märkl B, Urbach H, Roelz R. Do gliosarcomas have distinct imaging features on routine MRI? Neuroradiol J 2021; 34:501-508. [PMID: 33928823 PMCID: PMC8551440 DOI: 10.1177/19714009211012345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of this study was the development and external validation of a logistic regression model to differentiate gliosarcoma (GSC) and glioblastoma multiforme (GBM) on standard MR imaging. METHODS A univariate and multivariate analysis was carried out of a logistic regression model to discriminate patients histologically diagnosed with primary GSC and an age and sex-matched group of patients with primary GBM on presurgical MRI with external validation. RESULTS In total, 56 patients with GSC and 56 patients with GBM were included. Evidence of haemorrhage suggested the diagnosis of GSC, whereas cystic components and pial as well as ependymal invasion were more commonly observed in GBM patients. The logistic regression model yielded a mean area under the curve (AUC) of 0.919 on the training dataset and of 0.746 on the validation dataset. The accuracy in the validation dataset was 0.67 with a sensitivity of 0.85 and a specificity of 0.5. CONCLUSIONS Although some imaging criteria suggest the diagnosis of GSC or GBM, differentiation between these two tumour entities on standard MRI alone is not feasible.
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Affiliation(s)
- Christoph J Maurer
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Germany
| | - Irina Mader
- Department of Neuroradiology, Medical Center, University of Freiburg, Germany.,Department of Radiology, Schön-Klinik, Germany
| | - Felix Joachimski
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Augsburg, Germany
| | - Ori Staszewski
- Institute of Neuropathology, Faculty of Medicine, University of Freiburg, Germany
| | - Bruno Märkl
- Institute of Pathology, University Hospital Augsburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center, University of Freiburg, Germany
| | - Roland Roelz
- Department of Neurosurgery, Faculty of Medicine, University of Freiburg, Germany
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23
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Kiang KMY, Chan AA, Leung GKK. Secondary gliosarcoma: the clinicopathological features and the development of a patient-derived xenograft model of gliosarcoma. BMC Cancer 2021; 21:265. [PMID: 33706745 PMCID: PMC7948380 DOI: 10.1186/s12885-021-08008-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Gliosarcoma (GSM) is a distinct and aggressive variant of glioblastoma multiforme (GBM) with worse prognosis and few treatment options. It is often managed with the same treatment modalities with temozolomide (TMZ) as in GBM. However, the therapeutic benefits on GSM from such treatment regimen is largely unknown. Patient-derived xenograft (PDX) models have been used widely to model tumor progression, and subsequently to validate biomarkers and inform potential therapeutic regimens. Here, we report for the first time the successful development of a PDX model of secondary GSM. Methods Tissue obtained from a tumor resection revealed a secondary GSM arising from GBM. The clinical, radiological, and histopathological records of the patient were retrospectively reviewed. Samples obtained from surgery were cultured ex vivo and/or implanted subcutaneously in immunocompromised mice. Histopathological features between the primary GBM, secondary GSM, and GSM PDX are compared. Results In explant culture, the cells displayed a spindle-shaped morphology under phase contrast microscopy, consistent with the sarcomatous component. GSM samples were subcutaneously engrafted into immunocompromised mice after single-cell suspension. Xenografts of serial passages showed enhanced growth rate with increased in vivo passage. We did not observe any histopathological differences between the secondary GSM and its serial in vivo passages of PDX tumors. Conclusions Our PDX model for GSM retained the histopathological characteristics of the engrafted tumor from the patient. It may provide valuable information to facilitate molecular and histopathological modelling of GSM and be of significant implication in future research to establish precise cancer medicine for this highly malignant tumor.
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Affiliation(s)
- Karrie Mei-Yee Kiang
- Division of Neurosurgery, Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Andrian A Chan
- Division of Neurosurgery, Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China
| | - Gilberto Ka-Kit Leung
- Division of Neurosurgery, Department of Surgery, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China.
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24
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Tosoni A, Gessi M, Rindi G, Larghi A. Recurrent metastatic lung gliosarcoma diagnosed by EUS-guided fine-needle biopsy. Endosc Ultrasound 2021; 10:147-148. [PMID: 33473047 PMCID: PMC8098846 DOI: 10.4103/eus.eus_78_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Alberto Tosoni
- Department of Internal Medicine, Gastroenterology and Hepatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Gessi
- Department of Woman and Child Health and Public Health, Section of Pathology, Fondazion Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Guido Rindi
- Department of Woman and Child Health and Public Health, Section of Pathology, Fondazion Policlinico Universitario A. Gemelli IRCCS; Department of Life Sciences and Public Health, Section of Pathology, Catholic University, Rome, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS; Center for Endoscopic Research Therapeutics and Training, Catholic University, Rome, Italy
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25
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Lakhdar F, Benzagmout M, Chakour K, Chaoui MEF. Bumpy head, unusual gliosarcoma metastasis. Surg Neurol Int 2020; 11:311. [PMID: 33093988 PMCID: PMC7568115 DOI: 10.25259/sni_548_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022] Open
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26
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Gerges C, Elder T, Penuela M, Rossetti N, Maynard M, Jeong S, Wright CH, Wright J, Zhou X, Burant C, Sajatovic M, Hodges T. Comparative epidemiology of gliosarcoma and glioblastoma and the impact of Race on overall survival: A systematic literature review. Clin Neurol Neurosurg 2020; 195:106054. [PMID: 32650210 DOI: 10.1016/j.clineuro.2020.106054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/09/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Gliosarcoma (GSM) is a rare subtype of glioblastoma (GBM) that accounts for approximately four percent of high-grade gliomas. There is scarce epidemiological data on patients with GSM as a distinct subgroup of GBM. METHODS A systematic literature review was performed of peer-reviewed databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate the impact of race and ethnicity on survival in patients with GSM compared to patients with GBM. RESULTS Following initial abstract screening, a total of 138 articles pertaining to GSM and 275 pertaining to GBM met criteria for full-text review, with 5 and 27 articles included in the final analysis for GSM and GBM, respectively. The majority of patients in both cohorts were non-Hispanic Whites, representing 85.6 % of total GSM patients and 87.7 % of GBM patients analyzed. Two GSM studies stratified survival by race, with one reporting the longest median survival for the Hispanic population of 10.6 months and the shortest median survival for the Asian population of 9 months. Among the GBM studies analyzed, the majority of studies reported shorter survival and higher risk of mortality among White Non-Hispanics compared to non-White patients; and of the 15 studies which reported data for the Asian population, 12 studies reported this race category to have the longest survival compared to all other races studied. Younger age, female sex, MGMT promoter methylation status, and adjuvant chemoradiation therapy were associated with improved survival in both GSM and GBM cohorts, although these were not further stratified by race. CONCLUSION GSM portends a similarly poor prognosis to other GBM subtypes; however, few studies exist which have examined factors associated with differences in survival between these histologic variants. This review of the literature suggests there is a possible association between race and survival for patients with GBM, however data supporting this conclusion for patients with GSM is lacking. These findings suggest that GSM is a distinct disease from other GBM subtypes, with epidemiologic differences that should be further explored.
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Affiliation(s)
- Christina Gerges
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Theresa Elder
- Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA.
| | - Maria Penuela
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Nikki Rossetti
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Marquis Maynard
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Stacy Jeong
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA
| | - Christina Huang Wright
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
| | - James Wright
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Xiaofei Zhou
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Christopher Burant
- Mandel School of Applied Social Sciences Case Western Reserve University, Cleveland, OH, USA; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Research Center, University Hospitals Cleveland Medical Center, Cleveland, OH USA; Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Tiffany Hodges
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA; Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA
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27
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Jin MC, Liu EK, Shi S, Gibbs IC, Thomas R, Recht L, Soltys SG, Pollom EL, Chang SD, Hayden Gephart M, Nagpal S, Li G. Evaluating Surgical Resection Extent and Adjuvant Therapy in the Management of Gliosarcoma. Front Oncol 2020; 10:337. [PMID: 32219069 PMCID: PMC7078164 DOI: 10.3389/fonc.2020.00337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/26/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: Gliosarcomas are clinically aggressive tumors, histologically distinct from glioblastoma. Data regarding the impact of extent of resection and post-operative adjuvant therapy on gliosarcoma outcomes are limited. Methods: Patients with histologically confirmed gliosarcoma diagnosed between 1999 and 2019 were identified. Clinical, molecular, and radiographic data were assembled based on historical records. Comparisons of categorical variables used Pearson's Chi-square and Fisher's exact test while continuous values were compared using the Wilcoxon signed-rank test. Survival comparisons were assessed using Kaplan-Meier statistics and Cox regressions. Results: Seventy-one gliosarcoma patients were identified. Secondary gliosarcoma was not associated with worse survival when compared to recurrent primary gliosarcoma (median survival 9.8 [3.8 to 21.0] months vs. 7.6 [1.0 to 35.7], p = 0.7493). On multivariable analysis, receipt of temozolomide (HR = 0.02, 95% CI 0.001–0.21) and achievement of gross total resection (GTR; HR = 0.13, 95% CI 0.02–0.77) were independently prognostic for improved progression-free survival (PFS) while only receipt of temozolomide was independently associated with extended overall survival (OS) (HR = 0.03, 95% CI 0.001–0.89). In patients receiving surgical resection followed by radiotherapy and concomitant temozolomide, achievement of GTR was significantly associated with improved PFS (median 32.97 [7.1–79.6] months vs. 5.45 [1.8–26.3], p = 0.0092) and OS (median 56.73 months [7.8–104.5] vs. 14.83 [3.8 to 29.1], p = 0.0252). Conclusion: Multimodal therapy is associated with improved survival in gliosarcoma. Even in patients receiving aggressive post-operative multimodal management, total surgical removal of macroscopic disease remains important for optimal outcomes.
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Affiliation(s)
- Michael C Jin
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Elisa K Liu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Siyu Shi
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, United States
| | - Iris C Gibbs
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Reena Thomas
- Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Lawrence Recht
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Scott G Soltys
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Erqi L Pollom
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Steven D Chang
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, United States
| | - Melanie Hayden Gephart
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Seema Nagpal
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
| | - Gordon Li
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States.,Department of Neurology and Neurological Sciences, Stanford University Medical Center, Stanford, CA, United States
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28
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Anderson KJ, Tan AC, Parkinson J, Back M, Kastelan M, Newey A, Brewer J, Wheeler H, Hudson AL, Amin SB, Johnson KC, Barthel FP, Verhaak RGW, Khasraw M. Molecular and clonal evolution in recurrent metastatic gliosarcoma. Cold Spring Harb Mol Case Stud 2020; 6:mcs.a004671. [PMID: 31896544 PMCID: PMC6996521 DOI: 10.1101/mcs.a004671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/01/2019] [Indexed: 01/25/2023] Open
Abstract
We discuss the molecular evolution of gliosarcoma, a mesenchymal type of glioblastoma (GBM), using the case of a 37-yr-old woman who developed two recurrences and an extracranial metastasis. She was initially diagnosed with isocitrate dehydrogenase (IDH) wild-type gliosarcoma in the frontal lobe and treated with surgery followed by concurrent radiotherapy with temozolomide. Five months later the tumor recurred in the left frontal lobe, outside the initially resected area, and was treated with further surgery and radiotherapy. Six months later the patient developed a second left frontal recurrence and was again treated with surgery and radiotherapy. Six weeks later, further recurrence was observed in the brain and bone, and biopsy confirmed metastases in the pelvic bones. To understand the clonal relationships between the four tumor instances and the origin of metastasis, we performed whole-genome sequencing of the intracranial tumors and the tumor located in the right iliac bone. We compared their mutational and copy-number profiles and inferred the clonal phylogeny. The tumors harbored shared alterations in GBM driver genes, including mutations in TP53, NF1, and RB1, and CDKN2A deletion. Whole-genome doubling was identified in the first recurrence and the extracranial metastasis. Comparisons of the metastatic to intracranial tumors highlighted a high similarity in molecular profile but contrasting evidence regarding the origin of the metastasis. Subclonal reconstruction suggested a parallel evolution of the recurrent tumors, and that the metastatic tumor was largely derived from the first recurrence. We conclude that metastasis in glioma can be a late event in tumorigenesis.
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Affiliation(s)
- Kevin J Anderson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Aaron C Tan
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,National Cancer Centre Singapore, Singapore, 169610 Singapore
| | - Jonathon Parkinson
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia
| | - Michael Back
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia
| | - Marina Kastelan
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia
| | - Allison Newey
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia
| | - Janice Brewer
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia
| | - Helen Wheeler
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales 2065, Australia
| | - Amanda L Hudson
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia.,Bill Walsh Translational Cancer Research Laboratory, Kolling Institute of Medical Research, St Leonards, New South Wales 2065, Australia
| | - Samirkumar B Amin
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Kevin C Johnson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Floris P Barthel
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA.,Department of Pathology, VU University Medical Center/Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Roel G W Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut 06085, USA
| | - Mustafa Khasraw
- Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia.,The Brain Cancer Group, North Shore Private Hospital, St Leonards, New South Wales 2065, Australia.,The NHMRC Clinical Trials Centre, the University of Sydney, Camperdown, New South Wales 2066, Australia
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29
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Georgescu MM, Olar A. Genetic and histologic spatiotemporal evolution of recurrent, multifocal, multicentric and metastatic glioblastoma. Acta Neuropathol Commun 2020; 8:10. [PMID: 32014051 PMCID: PMC6998196 DOI: 10.1186/s40478-020-0889-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma is the most frequent and aggressive primary brain tumor, characterized by extensive brain invasion and rarely, systemic metastases. The pathogenesis of metastatic glioblastoma is largely unknown. We present the first integrated clinical/histologic/genetic analysis of 5 distinct brain and lung foci from a unique case of recurrent, multifocal, multicentric and metastatic glioblastoma. The initial right frontotemporal gliosarcoma received standard surgical/chemoradiation therapy and recurred 1.5 years later, co-occurring with three additional masses localized to the ipsilateral temporal lobe, cerebellum and lung. Synchronous metastatic lung carcinoma was suspected in this long-term smoker patient with family history of cancer. However, glioblastoma was confirmed in all tumors, although with different morphologic patterns, including ependymomatous and epithelioid. Genomic profiling revealed a germline FANCD2 variant of unknown significance, and a 4-gene somatic mutation signature shared by all tumors, consisting of TERT promoter and PTEN, RB1 and TP53 tumor suppressor mutations. Additional GRIN2A and ATM heterozygous mutations were selected in the cerebellar and lung foci, but were variably present in the supratentorial foci, indicating reduced post-therapeutic genetic evolution in brain foci despite morphologic variability. Significant genetic drift characterized the lung metastasis, likely explaining the known resistance of circulating glioblastoma cells to systemic seeding. MET overexpression was detected in the initial gliosarcoma and lung metastasis, possibly contributing to invasiveness. This comprehensive analysis sheds light on the temporospatial evolution of glioblastoma and underscores the importance of genetic testing for diagnosis and personalized therapy.
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30
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Choi MG, Lee JH, Lee MS, Suh SJ, Lee YS, Kang DG. Primary Gliosarcoma with Extracranial Metastasis. Brain Tumor Res Treat 2020; 8:53-56. [PMID: 32390354 PMCID: PMC7221469 DOI: 10.14791/btrt.2020.8.e9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 11/20/2022] Open
Abstract
A 69-year-old male presented with a week of worsening headache, mild dizziness and left side weakness, and the radiological work-up of his brain displayed an enhancing mass on the right frontal lobe. The tumor was totally resected. The patient was initially diagnosed with glioblastoma multiforme. His neurologic symptoms recovered after surgery. He underwent adjuvant radiotherapy with concurrent temozolomide. Approximately 7 months after surgery, the patient complained of epigastric pains. Abdominal CT scan showed multiple hepatic metastasis and multiple lymphadenopathy. Chest CT and Torso positron emission tomography-CT scans for additional metastasis study revealed multiple metastatic lesions in the right lung, left pleura, liver, lymph nodes, bones, and muscles. Percutaneous liver biopsy was performed, and associated pathology was consistent with sarcomatous component. After liver biopsy, brain tumor pathology was reviewed, which revealed typical gliomatous and sarcomatous components. The patient was therefore diagnosed with metastatic gliosarcoma. The patient was in a septic condition with aggravated pleural effusion. The patient died 9 months after the diagnosis of primary gliosarcoma.
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Affiliation(s)
- Min Gyu Choi
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Jeong Ho Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea.
| | - Min Seok Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Sang Jun Suh
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Yoon Soo Lee
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
| | - Dong Gee Kang
- Department of Neurosurgery, Daegu Fatima Hospital, Daegu, Korea
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31
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Tunthanathip T, Tawaranurak N, Kanjanapradit K. Extraneural metastatic gliosarcoma: A case report and review of the literature. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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32
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Nagaishi M, Fujii Y, Sugiura Y, Takano I, Takigawa T, Yokoo H, Suzuki K. Increased Twist and ZEB2 expression in a cutaneous metastasis of high-grade glioma. Neuropathology 2019; 40:196-201. [PMID: 31863511 DOI: 10.1111/neup.12621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/17/2019] [Accepted: 10/12/2019] [Indexed: 01/06/2023]
Abstract
Extra-central nervous system metastasis of gliomas is extremely rare, and the biological mechanism underlying it remains poorly understood. Epithelial-to-mesenchymal transition (EMT) has received attention as one of the important processes of cancer metastasis. Here we describe the case of a 32-year-old man with cutaneous metastasis of high-grade glioma, together with the analysis of EMT-related molecules. Our patient presented with a high-grade glioma in the right frontal lobe. Cutaneous metastasis under the surgical scar developed 17 months after complete resection of the intracranial tumor. Histopathology of both the original and metastatic tumors revealed hypercellularity; the tumors predominantly comprised glial tumor cells with poor cellular processes. Immunohistochemical analysis demonstrated intense expression of nestin, focal expression of glial fibrillary acid protein, and absence of expression of oligodendrocyte transcription factor 2, endothelial membrane antigen, or neurofilament. Genetic analyses could not provide definitive diagnostic information of glioma subtypes. Immunohistochemical analysis for EMT-related biomarkers demonstrated increased Twist, zinc finger E-box-binding homeobox 2 (ZEB2), matrix metalloproteinase 2 (MMP2), and MMP9 expressions in tumor cells of the metastatic lesion compared with those of the primary lesion. Slug, E-cadherin, and N-cadherin expression were absent in both primary and metastatic lesions; however, ZEB1 expression was present in both. Our results suggest that Twist, ZEB2, MMP2, and MMP9 facilitate cutaneous metastasis of gliomas.
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Affiliation(s)
- Masaya Nagaishi
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yoshiko Fujii
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yoshiki Sugiura
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Issei Takano
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tomoji Takigawa
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kensuke Suzuki
- Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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33
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Frandsen S, Broholm H, Larsen VA, Grunnet K, Møller S, Poulsen HS, Michaelsen SR. Clinical Characteristics of Gliosarcoma and Outcomes From Standardized Treatment Relative to Conventional Glioblastoma. Front Oncol 2019; 9:1425. [PMID: 31921679 PMCID: PMC6928109 DOI: 10.3389/fonc.2019.01425] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 11/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Gliosarcoma (GS) is a rare histopathologic variant of glioblastoma (GBM) characterized by a biphasic growth pattern consisting of both glial and sarcomatous components. Reports regarding its relative prognosis compared to conventional GBM are conflicting and although GS is treated as conventional GBM, supporting evidence is lacking. The aim of this study was to characterize demographic trends, clinical outcomes and prognostic variables of GS patients receiving standardized therapy and compare these to conventional GBM. Methods: Six hundred and eighty GBM patients, treated with maximal safe resection followed by radiotherapy with concomitant and adjuvant temozolomide at a single institution, were retrospectively reevaluated by reviewing histopathological records and tumor tissue for identification of GS patients. Clinico-pathological- and tumor growth characteristics were obtained via assessment of medical records and imaging analysis. Kaplan-Meier survival estimates were compared with log-rank testing, while Cox-regression modeling was tested for prognostic factors in GS patients. Results: The cohort included 26 primary gliosarcoma (PGS) patients (3.8%) and 7 secondary gliosarcoma (SGS) patients (1.0%). Compared to conventional GBM tumors, PGS tumors were significantly more often MGMT-unmethylated (73.9%) and located in the temporal lobe (57.7%). GS tumors often presented dural contact, while extracranial metastasis was only found in 1 patient. No significant differences were found between PGS and conventional GBM in progression-free-survival (6.8 and 7.6 months, respectively, p = 0.105) and in overall survival (13.4 and 15.7 months, respectively, p = 0.201). Survival following recurrence was not significantly different between PGS, SGS, and GBM. Temporal tumor location and MGMT status were found associated with PGS survival (p = 0.036 and p = 0.022, respectively). Conclusion: Despite histopathological and location difference between GS and GBM tumors, the patients present similar survival outcome from standardized treatment. These findings support continued practice of radiation and temozolomide for GS patients.
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Affiliation(s)
- Simone Frandsen
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark
| | - Helle Broholm
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark
| | | | - Kirsten Grunnet
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark
| | - Søren Møller
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Signe Regner Michaelsen
- Department of Radiation Biology, Rigshospitalet, Copenhagen, Denmark.,Biotech Research and Innovation Centre (BRIC), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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34
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Identification of Distant Metastases From Recurrent Gliosarcoma Using Whole-Body 18F-FDG PET/CT. Clin Nucl Med 2019; 44:923-924. [PMID: 31584491 DOI: 10.1097/rlu.0000000000002790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 51-year-old man presented with recurrent gliosarcoma and increasing cough over the last months. On F-FDG PET/CT, solid lung masses with high F-FDG uptake were present. A biopsy taken from a lung lesion indicated distant metastases from gliosarcoma. Gliosarcoma, a rare malignant central nervous system tumor, presents with extracranial metastases in only less than 10%. As highlighted by this case, F-FDG PET/CT can be used for whole-body staging in patients with metastatic brain tumor. Vice versa, highly F-FDG-avid lung lesions in patients with brain tumors should lead to distant metastases as differential diagnosis despite their rare occurrence.
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35
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Capion T, Hauerberg J, Broholm H, Muhic A. Multiple Extracranial Metastases from Primary Gliosarcoma in a Patient with Two Previous Different Primary Cancers. Case Rep Oncol Med 2019; 2019:7849616. [PMID: 31565453 PMCID: PMC6745105 DOI: 10.1155/2019/7849616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/26/2019] [Accepted: 08/08/2019] [Indexed: 01/15/2023] Open
Abstract
Gliosarcoma (GS) constitutes a minor fraction of primary glioblastoma (GBM), which is the most frequent malignant brain tumor in adults. Despite the fact that malignant gliomas are highly invasive, extracranial metastases are very rarely seen, and the mechanisms behind extracranial dissemination are still unclarified. We report a case of a 55-year-old male with a prior history of two distinct primary cancer types who, as a third independent type, developed GS with penetrating tumor growth to the skull and subcutaneous soft tissue via explosive spreading through a titanium net as well as extracranial metastases to the lumbar spine, paravertebral musculature, and most likely the right lung. The case illuminates the clinical challenge of diagnosing extracranial metastases from primary GBM and GS as these are still unexpected, especially in cases with possible competing diagnoses.
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Affiliation(s)
- T. Capion
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - J. Hauerberg
- Department of Neurosurgery, The Neuroscience Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - H. Broholm
- Department of Pathology, Center of Diagnostic Investigation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - A. Muhic
- Department of Oncology, The Finsen Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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36
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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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37
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Saadeh F, El Iskandarani S, Najjar M, Assi HI. Prognosis and management of gliosarcoma patients: A review of literature. Clin Neurol Neurosurg 2019; 182:98-103. [PMID: 31112812 DOI: 10.1016/j.clineuro.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022]
Abstract
Gliosarcoma (GSM) is a variant of glioblastoma (GBM), the most common primary malignant brain tumor that occurs in adults. GSM is characterized by its biphasic components: the gliomatous and sarcomatous components and categorized into primary and secondary GSM. Intrinsic to the brain parenchyma, GSM is usually managed by gross total resection, and radiotherapy with/without chemotherapy. While the benefits of treatment remain unclear, cases have always been managed similar to GBM cases yielding different treatment outcomes between the two groups. The scarcity of research done on GSM suggests that further investigation is needed. Genetic studies on tumor samples and an in-depth examination of tumor subtypes and categories could result in identification of certain targetable alterations. The objective of this review is to summarize the available findings on characteristics, prognosis and management of GSM patients.
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Affiliation(s)
- Fadi Saadeh
- American University of Beirut, Faculty of Medicine, Beirut, Lebanon
| | | | - Marwan Najjar
- American University of Beirut Medical Center, Department of Surgery, Beirut, Lebanon
| | - Hazem I Assi
- American University of Beirut Medical Center, Department of Internal Medicine, Hematology and Oncology, Naef K. Basile Cancer Institute, Beirut, Lebanon.
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38
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Ahmed FI, Abdullah KG, Durgin J, Salinas RD, O'Rourke DM, Brem S. Evaluating the Association Between the Extent of Resection and Survival in Gliosarcoma. Cureus 2019; 11:e4374. [PMID: 31218139 PMCID: PMC6553678 DOI: 10.7759/cureus.4374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Gliosarcoma (GS) is a rare, malignant mixed tumor of the central nervous system with a median survival of approximately 13 months across multiple studies. Although the value of the extent of resection (EOR) has been confirmed as a prognostic survival factor in glioblastoma, no such association has been defined for GS. The goal of this study was to establish an association between EOR and survival and to determine if a threshold of resection exists for which a survival benefit is conferred in GS. Methods: The authors identified 11 patients with histologically confirmed GS between January 2005 and January 2015, treated at the Hospital of the University of Pennsylvania. Clinical, radiographic, and outcome data were retrospectively reviewed. Volumetric analysis was completed using semi-automated segmentation to measure the change in contrast-enhancing material based on preoperative T1-contrast (T1c) and postoperative T1 & T1c magnetic resonance imaging (MRI) scans. A log-rank test was completed to confirm an association between EOR and survival, and a series of Kaplan-Meier curves were constructed to determine an EOR threshold. Univariate Cox proportional hazards model (CPHM) followed by multivariate CPHM was also completed to evaluate associations between the prognostic clinical and immunohistochemistry variables under consideration. Results: Extent of resection categories were defined as gross total resection (GTR >95%), subtotal resection (STR 90%-95%), and partial resection (PR <90%). The median overall survival for the groups were as follows: GTR-17.3 months (n=4), STR-12.6 months (n=5), PR-4.3 months (n=2). A statistically significant association (p=05 level) was found between survival and the PR group with the GTR group as reference. Multivariate CPHM confirmed a statistically significant association between increased survival and age, preoperative Karnofsky Performance Status (KPS) scores, postoperative KPS scores, and KI-67 index. Serial Kaplan-Meier curves suggest a survival benefit with an EOR threshold of 94%. Conclusion: This study agrees with previous correlations in glioblastoma EOR and prolonged survival. For patients undergoing surgical resection for GS, maximal surgical removal, when safely possible, should be attempted as it appears to translate to longer survival times.
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Affiliation(s)
- Fahad I Ahmed
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Kalil G Abdullah
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Joseph Durgin
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Ryan D Salinas
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Donald M O'Rourke
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Steven Brem
- Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, USA
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39
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Wojtas B, Gielniewski B, Wojnicki K, Maleszewska M, Mondal SS, Nauman P, Grajkowska W, Glass R, Schüller U, Herold-Mende C, Kaminska B. Gliosarcoma Is Driven by Alterations in PI3K/Akt, RAS/MAPK Pathways and Characterized by Collagen Gene Expression Signature. Cancers (Basel) 2019; 11:cancers11030284. [PMID: 30818875 PMCID: PMC6468745 DOI: 10.3390/cancers11030284] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 01/15/2023] Open
Abstract
Gliosarcoma is a very rare brain tumor reported to be a variant of glioblastoma (GBM), IDH-wildtype. While differences in molecular and histological features between gliosarcoma and GBM were reported, detailed information on the genetic background of this tumor is lacking. We intend to fill in this knowledge gap by the complex analysis of somatic mutations, indels, copy number variations, translocations and gene expression patterns in gliosarcomas. Using next generation sequencing, we determined somatic mutations, copy number variations (CNVs) and translocations in 10 gliosarcomas. Six tumors have been further subjected to RNA sequencing analysis and gene expression patterns have been compared to those of GBMs. We demonstrate that gliosarcoma bears somatic alterations in gene coding for PI3K/Akt (PTEN, PI3K) and RAS/MAPK (NF1, BRAF) signaling pathways that are crucial for tumor growth. Interestingly, the frequency of PTEN alterations in gliosarcomas was much higher than in GBMs. Aberrations of PTEN were the most frequent and occurred in 70% of samples. We identified genes differentially expressed in gliosarcoma compared to GBM (including collagen signature) and confirmed a difference in the protein level by immunohistochemistry. We found several novel translocations (including translocations in the RABGEF1 gene) creating potentially unfavorable combinations. Collected results on genetic alterations and transcriptomic profiles offer new insights into gliosarcoma pathobiology, highlight differences in gliosarcoma and GBM genetic backgrounds and point out to distinct molecular cues for targeted treatment.
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Affiliation(s)
- Bartosz Wojtas
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland.
| | - Bartlomiej Gielniewski
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland.
| | - Kamil Wojnicki
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland.
| | - Marta Maleszewska
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland.
| | - Shamba S Mondal
- Laboratory of Bioinformatics, Nencki Institute of Experimental Biology, Warsaw 02-093, Poland.
| | - Pawel Nauman
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw 02-957, Poland.
| | - Wieslawa Grajkowska
- Department of Pathology, The Children's Memorial Health Institute, Warsaw 04-730, Poland.
| | - Rainer Glass
- Neurosurgical Research, University Clinics, LMU Munich 80539, Germany.
| | - Ulrich Schüller
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf 20251, Germany.
- Research Institute Children's Cancer Center Hamburg, Hamburg 20251, Germany.
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg 20251, Germany.
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg 69120, Germany.
| | - Bozena Kaminska
- Laboratory of Molecular Neurobiology, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland.
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Schou Nørøxe D, Regner Michaelsen S, Broholm H, Møller S, Skovgaard Poulsen H, Lassen U. Extracranial metastases in glioblastoma-Two case stories. Clin Case Rep 2019; 7:289-294. [PMID: 30847191 PMCID: PMC6389476 DOI: 10.1002/ccr3.1980] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/26/2018] [Accepted: 12/02/2018] [Indexed: 12/13/2022] Open
Abstract
The clinician should always consider extracranial metastases in glioblastoma. Increased risk factors are young age at diagnosis, histology of gliosarcoma, and prior intracranial tumor surgery. Clinical guidelines are needed for this rare event, including consideration for prophylactic intervention.
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Affiliation(s)
- Dorte Schou Nørøxe
- Department of Radiation BiologyRigshospitaletCopenhagenDenmark
- Department of OncologyRigshospitaletCopenhagenDenmark
| | | | - Helle Broholm
- Department of PathologyRigshospitaletCopenhagenDenmark
| | - Søren Møller
- Department of OncologyRigshospitaletCopenhagenDenmark
| | - Hans Skovgaard Poulsen
- Department of Radiation BiologyRigshospitaletCopenhagenDenmark
- Department of OncologyRigshospitaletCopenhagenDenmark
| | - Ulrik Lassen
- Department of OncologyRigshospitaletCopenhagenDenmark
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Bohn A, Braley A, Rodriguez de la Vega P, Zevallos JC, Barengo NC. The association between race and survival in glioblastoma patients in the US: A retrospective cohort study. PLoS One 2018; 13:e0198581. [PMID: 29927955 PMCID: PMC6013158 DOI: 10.1371/journal.pone.0198581] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Glioblastoma is the most common primary brain cancer in adults with an incidence of 3.4 per 100,000, making up about 15% of all brain tumors. Inconsistent results have been published in regard differences in survival between white and black glioblastoma patients. The objective of this to study the association between race and in Glioblastoma patients in the USA during 2010-2014. METHODS AND FINDINGS The National Cancer Institute's Surveillance Epidemiology and End Results (SEER) database were used to evaluate race/ethnicity (White non-Hispanic, Black non-Hispanic, Asian/Pacific Islanders non-Hispanic (API)) and Hispanic) adults patients with first-time diagnosis of glioblastoma (International Classification of Diseases for Oncology, 3rd Edition [ICD-O-3], codes C711-C714, and histology type 9440/3) from 2010-2014. The primary outcome was 3-year overall survival which was defined as months from diagnosis to death due to any cause and cancer, Kaplan-Meier (KM) and log-rank test were used to compare overall survival times across race groups. Cox proportional hazard models were used to determine the independent effect of race on 3-year survival. Age, gender, health insurance coverage, primary site, tumor size, extent of surgery and year of diagnosis were included in the adjusted model. The 3-year overall survival for API-non Hispanic (NH) patients decreased by 25% compared with White NH glioblastoma patients (hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.62-0.90)) after adjusting for age, gender, health insurance, primary site, tumor size, and extent of the surgery. Black NH (HR 0.95; 95% CI 0.80-1.13) and Hispanic (HR 1.01, 95% CI 0.84-1.21) exhibited similar mortality risks compared with White NH patients. CONCLUSION Compared with White NH, API NH with glioblastoma have a better survival. The findings from this study can help increase the accuracy of the prognostic outlook for white, black and API patients with GBM.
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Affiliation(s)
- Andrew Bohn
- Department of Medical and Health Science Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Alexander Braley
- Department of Medical and Health Science Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Pura Rodriguez de la Vega
- Department of Medical and Health Science Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Juan Carlos Zevallos
- Department of Medical and Health Science Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
| | - Noël C. Barengo
- Department of Medical and Health Science Research, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, United States of America
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Srivastava H, Dewan A, Sharma SK, Negi P, Dewan AK, Pasricha S, Mehrotra K. Adjuvant Radiation Therapy and Temozolomide in Gliosarcoma: Is It Enough? Case Series of Seven Patients. Asian J Neurosurg 2018; 13:297-301. [PMID: 29682024 PMCID: PMC5898095 DOI: 10.4103/ajns.ajns_151_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: We present our experience of gliosarcoma (GSM) in oncology tertiary care center over the last 5 years. Materials and Methods: We carried out a retrospective analysis of seven patients with GSM diagnosed between April 2008 and December 2012. Demographic data, clinicopathological data, treatment strategies employed, details of recurrence, and survival patterns were reviewed. Results: The median age at diagnosis was 54 years, ranging between 34 and 63 years with a female predominance (57.1% females). Headache and neurological deficit were the most common symptoms with parietal region being the most common site of lesion. Subtotal resection followed by concurrent chemoradiation therapy was delivered to six patients. The results following completion of planned schedule of concurrent chemoradiotherapy were quite disappointing with two patients having no evidence of disease, one patient was lost to follow-up, and other three had progressive disease. One patient with progressive disease subsequently received eight cycles of bevacizumab on a clinical trial protocol. Fifteen-month posttreatment, she had stable disease on follow-up. Conclusions: Our experience suggests that despite treatment, the diagnosis of GSM portends a poor prognosis and the use of bevacizumab could represent a treatment approach to improve outcome in these patients. Although the role of targeted therapy in GSM remains unclear because of paucity of experience, the treatment decision should be according to patient's performance status, ability, and willingness to receive additional treatment.
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Affiliation(s)
- Himanshu Srivastava
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Abhinav Dewan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Surender Kumar Sharma
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Preety Negi
- Department of Radiation Oncology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Ajay Kumar Dewan
- Department of Neurosurgery, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
| | - Krati Mehrotra
- Department of Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India
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Ma R, Alexe DM, Pereira EA. Primary gliosarcoma: epidemiology, clinical presentation, management, and survival. J Neurosurg Sci 2017; 64:341-346. [PMID: 29154508 DOI: 10.23736/s0390-5616.17.04077-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Gliosarcomas are malignant tumors of the central nervous system. As a variant of glioblastomas (GBM), they are treated in a similar fashion. However, there is growing evidence to suggest that they may be a separate entity. METHODS Due to the rarity of primary gliosarcomas (PGS), here we publish data from a single center spanning over 14 years, comprising possibly one of the biggest case series in the literature to our knowledge. RESULTS The mean age at presentation was 59 years with male preponderance (1.75:1). The most common presenting symptoms were balance and mobility issues (61%), followed by headaches (50%) and visual problems (39%). Tumours were most likely to involve the frontal and parietal lobes (27% and 21% respectively). Patients under 50 had a significant survival advantage (50% versus 32%). All patients had surgery, 79% had adjuvant radiotherapy, with a further 21% also receiving chemotherapy. Median survival from surgery of patients diagnosed with PGS was 6.6 months. Median and one-year survival were significantly better for patients who received radiotherapy (14 months; 46% one year survival) and improved further with combined radio- and chemotherapy (30 months; 77%, one year survival). CONCLUSIONS For patients of good functional status, adjuvant chemo-radiotherapy is warranted and should be offered as it confers a much-improved overall survival.
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Affiliation(s)
- Ruichong Ma
- Department of Neurosurgery, Oxford University Hospitals, Oxford, UK
| | | | - Erlick A Pereira
- Department of Neurosurgery, Oxford University Hospitals, Oxford, UK -
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Shin JY, Yoon JK, Diaz AZ. Gliosarcoma in septuagenarians and octogenarians: What is the impact of adjuvant chemoradiation? J Clin Neurosci 2017; 45:77-82. [DOI: 10.1016/j.jocn.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
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Sun Q, Xu R, Xu H, Wang G, Shen X, Jiang H. Extracranial metastases of high-grade glioma: the clinical characteristics and mechanism. World J Surg Oncol 2017; 15:181. [PMID: 28985756 PMCID: PMC5639596 DOI: 10.1186/s12957-017-1249-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background This presentation of two cases and literature review discusses the epidemiology, clinical manifestations, pathogenesis, diagnosis, treatment, and prognosis of high-grade glioma with extracranial metastases. Methods A retrospective analysis of the clinical features of two cases of malignant glioma, including metastatic sites, pathological data, and treatment methods, and a literature review was performed. Results Two patients developed extracranial metastases within 1 year after surgery for primary glioma. One patient developed cervical lymph node and bone metastases while the other developed bone metastases, and both patients died within 2 months after the diagnosis of the extracranial metastasis. Conclusion Extracranial metastases may develop from malignant gliomas. According to the literature, the most common extracranial site is intraspinal (along the neural axis), followed by the vertebrae, lungs, liver, and lymph nodes. The complex metastatic mechanism remains unclear, and the prognosis is very poor, with a survival duration of less than 6 months.
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Affiliation(s)
- Qian Sun
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Rui Xu
- Department of Surgical Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Hongbo Xu
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Gengming Wang
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Xueming Shen
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China
| | - Hao Jiang
- Department of Radiation Oncology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, 233000, China.
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Sampaio L, Linhares P, Fonseca J. Detailed magnetic resonance imaging features of a case series of primary gliosarcoma. Neuroradiol J 2017. [PMID: 28644110 DOI: 10.1177/1971400917715879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective We aimed to characterise the magnetic resonance imaging (MRI) features of a case series of primary gliosarcoma, with the inclusion of diffusion-weighted imaging and perfusion imaging with dynamic susceptibility contrast MRI. Materials and methods We conducted a retrospective study of cases of primary gliosarcoma from the Pathology Department database from January 2006 to December 2014. Clinical and demographic data were obtained. Two neuroradiologists, blinded to diagnosis, assessed tumour location, signal intensity in T1 and T2-weighted images, pattern of enhancement, diffusion-weighted imaging and dynamic susceptibility contrast MRI studies on preoperative MRI. Results Seventeen patients with primary gliosarcomas had preoperative MRI study: seven men and 10 women, with a mean age of 59 years (range 27-74). All lesions were well demarcated, supratentorial and solitary (frontal n = 5, temporal n = 4, parietal n = 3); 13 tumours abutted the dural surface (8/13 with dural enhancement); T1 and T2-weighted imaging patterns were heterogeneous and the majority of lesions (12/17) showed a rim-like enhancement pattern with focal nodularities/irregular thickness. Restricted diffusion (mean apparent diffusion coefficient values 0.64 × 10-3 mm2/s) in the more solid/thick components was present in eight out of 11 patients with diffusion-weighted imaging study. Dynamic susceptibility contrast MRI study ( n = 8) consistently showed hyperperfusion in non-necrotic/cystic components on relative cerebral volume maps. Conclusions The main distinguishing features of primary gliosarcoma are supratentorial and peripheral location, well-defined boundaries and a rim-like pattern of enhancement with an irregular thick wall. Diffusion-weighted imaging and relative cerebral volume map analysis paralleled primary gliosarcoma with high-grade gliomas, thus proving helpful in differential diagnosis.
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Affiliation(s)
- Luísa Sampaio
- 1 Neuroradiology Department, Centro Hospitalar de São João, Portugal
| | - Paulo Linhares
- 2 Neurosurgery Department, Centro Hospitalar de São João, Portugal.,3 Faculty of Medicine, Porto University, Portugal
| | - José Fonseca
- 1 Neuroradiology Department, Centro Hospitalar de São João, Portugal
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Konar SK, Bir SC, Maiti TK, Patra DP, DiPoto Brahmbhatt AC, Jacobsohn JA, Nanda A. Early dural metastasis from a case of glioblastoma with primitive neuroectodermal differentiation: A case report and literature review. J Clin Neurosci 2017; 35:78-81. [DOI: 10.1016/j.jocn.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
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Lee J, Rodriguez F, Ali SZ. Metastatic Gliosarcoma: Cytopathologic Characteristics with Histopathologic Correlations. Acta Cytol 2016; 60:490-494. [PMID: 27584833 DOI: 10.1159/000448509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/18/2016] [Indexed: 11/19/2022]
Abstract
Gliosarcoma is a rare variant of glioblastoma multiforme characterized by a biphasic pattern of glial and mesenchymal differentiation. Fine-needle aspiration (FNA) is routinely employed to diagnose a number of primary and secondary malignancies in a variety of clinical settings. Herein, we describe the cytomorphologic features of a gliosarcoma metastatic to an extracranial location accompanied by corresponding clinico-radiologic and histopathologic findings in a 51-year-old man with a posterior mediastinal mass. The cytologic smears displayed a pleomorphic tumor comprised of spindled and epithelioid malignant cells. This case illustrates the ability of FNA to adequately diagnose a rare malignancy in the appropriate clinico-radiologic setting.
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Affiliation(s)
- James Lee
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Md., USA
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Mason A, Villavicencio AT, Nelson EL, Forsythe RC, Burneikiene S. Post-Treatment Gliosarcoma Extension into the Pterygomaxillary Fossa: Literature Review and Case Report. Cureus 2016; 8:e700. [PMID: 27699141 PMCID: PMC5040629 DOI: 10.7759/cureus.700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Only four primary gliosarcoma case reports are described in the literature with transcranial (intradural to extradural) penetration into the region of the infratemporal fossa. This is the first report of a primary glioblastoma (GBM) that evolved into secondary or post-treatment gliosarcoma without evidence of a second de novo tumor and with extension into the left pterygomaxillary fossa.
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Castelli J, Feuvret L, Haoming QC, Biau J, Jouglar E, Berger A, Truc G, Gutierrez FL, Morandi X, Le Reste PJ, Thillays F, Loussouarn D, Nouhaud E, Crehange G, Antoni D, Vauleon E, de Crevoisier R, Noel G. Prognostic and therapeutic factors of gliosarcoma from a multi-institutional series. J Neurooncol 2016; 129:85-92. [DOI: 10.1007/s11060-016-2142-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022]
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