Abstract
Introduction: Gliosarcoma is rare primary malignant tumor of brain and is a histological variant of glioblastoma. This supratentorial tumor usually affects older age groups and is extremely rare in paediatric population. Morphologically characterized by a biphasic pattern having a gliomatous GFAP positive component alternating with a vimentin positive sarcomatous component. Immunohistochemical analysis is of immense help in confirmatory diagnosis by pathologists. Being a WHO grade IV tumor it bears a poor prognosis despite concomitant surgical and chemo radiation therapies. The present study was conducted to study the clinical and histomorphological features of gliosarcoma at a tertiary care institute.
Materials and Methods: A retrospective cross-sectional study was conducted at SMS Medical College, Jaipur during study period January 2013 to December 2018.
Results: 12 cases of gliosarcoma were reviewed out of which 4 (33.3%) cases belonged to paediatric age group. Mean age of study subjects was 32.9 years. Most frequent site of tumor was left temporoparietal (25%) followed by left frontotemporoparietal (16.7%). All patients presented with headache and vomiting. The most frequent associated symptom was altered consciousness followed by seizures. Light microscopic studies revealed mixed tumor with glial and sarcomatous components showing immunopositivity for GFAP and Vimentin respectively and a high proliferative index.
Conclusion: In present study a younger population was affected, so gliosarcoma should be kept as a differential diagnosis while evaluating supratentorial tumor in pediatric population as well. Immunohistochemical studies must be carried out to reach at the accurate diagnosis and to support treatment strategies.
Keywords: Glial tumor, gliosarcoma, immunohistochemistry, paediatric.
References
- Kozak KR, Mahadevan A, Moody JS. Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol. 2009;11(2):183–191.
- di Norcia V, Piccirilli M, Giangaspero F, Salvati M. Gliosarcomas in the elderly: analysis of 7 cases and clinico-pathological remarks. 2008;94(4):493–496
- Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P: The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114: 97-109
- Lutterbach J, Guttenberger R, Pagenstecher A. Gliosarcoma: a clinical study. Radiother Oncol. 2001;61(1):57–64.
- Stroebe H. Uber entstehung und bau der hirngliome. BeitrPatholAnat1895;18:405-86
- Biswas A, Kumar N, Kumar P, Vasishta RK, Gupta K, Sharma SC, Patel F. et al. Primary gliosarcoma - clinical experience from a regional cancer centre in north India. Br J Neurosurg. 2011;25(6):723–729
- Kumar P, Singh S, Krishnani N, Datta NR. Gliosarcoma: an audit from a single institution in India of 24 post-irradiated cases over 15 years. J Cancer Res Ther. 2008;4(4):164–168.
- Kakkar N, Kaur J, Singh GK, Singh P, Siraj F, Gupta A. Gliosarcoma in Young Adults: A Rare Variant of Glioblastoma. World J Oncol. 2017;8(2):53–57.
- Witwer BP, Salamat MS, Resnick DK: Gliosarcoma metastatic to the cervical spinal cord: case report and review of the literature. Surg Neurol. 2000;54: 373-378
- .Vukelic Z, Kalanj-Bognar S, Froesch M, Bindila L, Radic B, Allen M, Peter-Katalinic J. et al. Human gliosarcoma-associated ganglioside composition is complex and distinctive as evidenced by high-performance mass spectrometric determination and structural characterization. 2007;17(5):504–515.
- Galanis E, Buckner JC, Dinapoli RP, Scheithauer BW, Jenkins RB, Wang CH, O'Fallon JR. et al. Clinical outcome of gliosarcoma compared with glioblastoma multiforme: North Central Cancer Treatment Group results. J Neurosurg. 1998;89(3):425–430.
- Khanna M, Siraj F, Chopra P, Bhalla S, Roy S. Gliosarcoma with prominent smooth muscle component (gliomyosarcoma): a report of 10 cases Indian J Pathol Microbiol. 2011;54(1):51–54.
- Salvati M, Caroli E, Raco A, Giangaspero F, Delfini R, Ferrante L. Gliosarcomas: analysis of 11 cases do two subtypes exist? J Neurooncol. 2005;74(1):59–63
- Faried, A., Hernowo, B.S., Adam, A., Arifin, M.Z. Temporoparietal Gliosarcoma: A Case Report with Literature Review. Indonesian Journal of Neurosurgery 2018; 1(1): 19-22
- Beaumont TL, Kupsky WJ, Barger GR, Sloan AE: Gliosarcoma with multiple extra-cranial metastases: case report and review of literature. J Neurooncol. 2007;83: 39-46
- Han SJ, Yang I, Tihan T, Prados MD, Parsa AT. Primary gliosarcoma: key clinical and pathologic distinctions from glioblastoma with implications as a unique oncologic entity. J Neurooncol. 2010;96(3):313–320.
- Walker GV, Gilbert MR, Prabhu SS, Brown PD, McAleer MF. Temozolomide use in adult patients with gliosarcoma: an evolving clinical practice. J Neurooncol. 2013;112(1):83–89
- Han SJ, Yang I, Tihan T, Chang SM, Parsa AT. Secondary gliosarcoma: a review of clinical features and pathological diagnosis. J Neurosurg. 2010;112(1):26–32.
Corresponding Author
Vijay Ramita
Postgraduate Student, Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.162
