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Cerebral gliosarcoma: Analysis of 16 patients and review of literature.

Singh G, Das KK, Sharma P, Guruprasad B, Jaiswal S, Mehrotra A, Srivastava AK, Sahu RN, Jaiswal AK, Behari S - Asian J Neurosurg (2015 Jul-Sep)

Bottom Line: Patients with well-demarcated, enhancing mass on imaging intraoperatively had firm tumors with a good plane of cleavage and had a better survival (8 months) compared to those in whom the tumor radiologically and intraoperatively mimicked GBM (2 months).GS is associated with poor survival (median survival 6 months).While the former histologically mimics GBM and has very poor survival (2 months), GS with meningioma like feature tends to have better survival (8 months).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India.

ABSTRACT

Background: Gliosarcoma (GS), a subtype of glioblastoma (GBM), is a rare primary neoplasm of the central nervous system. Certain features like temporal lobe affinity, tendency for extraneural metastasis and poorer outcome compared to GBM indicate that GS may indeed be a separate clinicopathologic entity. This led us to revisit this entity in our settings.

Materials and methods: Between 2009 and 2014, 16 cases of histologically proven GSs (14 primary, two secondary) were treated. Patient data were retrieved retrospectively. Statistical analysis was performed with? Statistical Package for Social Sciences, version 17.0. (Chicago, Illinois, USA). Survival was analyzed by Kaplan-Meier method.

Results: GS predominantly affected males in their fifth decade of life. Raised intracranial pressure was the most common mode of clinical presentation. Temporal lobe was the most commonly affected part of the brain and majority of primary and all of secondary GBM were located peripherally. In 7 (43.8%) patients, tumor was radiologically well-demarcated and enhanced strongly and homogenously on contrast as compared to 9 (56.2%) patients where the tumor was ill-defined and showed heterogenous patchy or ring enhancement. Extent of excision was total in seven patients (43.8%), near total in 4 (25%) and subtotal in five patients (31.2%). Median survival was 6 months. Patients with well-demarcated, enhancing mass on imaging intraoperatively had firm tumors with a good plane of cleavage and had a better survival (8 months) compared to those in whom the tumor radiologically and intraoperatively mimicked GBM (2 months).

Conclusion: GS is associated with poor survival (median survival 6 months). Radiological and intraoperative findings help categorize these tumors into GBM like GS and meningioma like GS. While the former histologically mimics GBM and has very poor survival (2 months), GS with meningioma like feature tends to have better survival (8 months).

No MeSH data available.


Related in: MedlinePlus

Hyperdensity suggestive of bleed in left subcortical temporal lobe (a). The lesion appeared hyperintense on T1 and hypointense on T2 further demonstrating bleed inside the lesion (b and c). After resolution of hematoma, a peripherally enhancing mass lesion can be seen on axial computed tomography (1-year after initial bleed) (d). Postoperative computed tomography scan showed complete excision of tumor (e)
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Figure 1: Hyperdensity suggestive of bleed in left subcortical temporal lobe (a). The lesion appeared hyperintense on T1 and hypointense on T2 further demonstrating bleed inside the lesion (b and c). After resolution of hematoma, a peripherally enhancing mass lesion can be seen on axial computed tomography (1-year after initial bleed) (d). Postoperative computed tomography scan showed complete excision of tumor (e)

Mentions: Majority of the patients had involvement of one lobe only (n = 12, 75%) while remaining patients had tumor extending into adjoining lobe (two lobe involvement) (n = 4, 25%). Temporal lobe was the most common site of involvement (n = 8, 50%) followed by frontal and parietal lobes (n = 2, 12.5% each). Among multilobular tumors, two patients had tumor located at fronto parietal lobe, one patient each had tumor located at the peritrigonal region (parieto-temporo-occipital junction) and anterior corpus callosum with bifrontal extension (6.2%). There were 14 (87.5%) peripheral tumors while two patients had deep tumors (12.5%). Both secondary GS was superficially located (100%) over the cerebral lobes while 12 out of 14 primary GS showed a peripheral location (85.7%). There was no evidence of calcification inside the tumor. One patient had radiological evidence of bleed inside it [Figure 1]. Average tumor size was 5.1 cm [range: 3–6 cm]. Majority (n = 12, 75%) of the tumors were totally solid (with or without necrotic areas) and four patients (25%) had large cystic component, two of whom had the appearance of mural nodule (12.5%). All lesions were hypo intense on T1, heterointense on T2 and enhanced variably on contrast. Enhancement was intense and homogenous in 7 (43.8%), intense but heterogenous in 4 (25%) and patchy/ring type enhancement was seen in five patients (31.2%) [Figures 2 and 3]. The wall of the cystic component also showed enhancement with contrast. Although majority of the tumors were peripherally located, dural tail sign was present only in four patients (25%). All patients had peritumoral edema and mass effect. All lesions were single, and there were no evidences of multifocality. Angiographic study was available in one patient who presented with intratumoral bleed. However, no abnormality was detected. Similar to the primary GS, secondary GS also showed inconsistent imaging findings. One of the patients with secondary GS had superficial dural-based mass with dural tail sign [Figure 4] while the second patient had a subcortical ill-defined mass with patchy enhancement [Figure 5].


Cerebral gliosarcoma: Analysis of 16 patients and review of literature.

Singh G, Das KK, Sharma P, Guruprasad B, Jaiswal S, Mehrotra A, Srivastava AK, Sahu RN, Jaiswal AK, Behari S - Asian J Neurosurg (2015 Jul-Sep)

Hyperdensity suggestive of bleed in left subcortical temporal lobe (a). The lesion appeared hyperintense on T1 and hypointense on T2 further demonstrating bleed inside the lesion (b and c). After resolution of hematoma, a peripherally enhancing mass lesion can be seen on axial computed tomography (1-year after initial bleed) (d). Postoperative computed tomography scan showed complete excision of tumor (e)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4553731&req=5

Figure 1: Hyperdensity suggestive of bleed in left subcortical temporal lobe (a). The lesion appeared hyperintense on T1 and hypointense on T2 further demonstrating bleed inside the lesion (b and c). After resolution of hematoma, a peripherally enhancing mass lesion can be seen on axial computed tomography (1-year after initial bleed) (d). Postoperative computed tomography scan showed complete excision of tumor (e)
Mentions: Majority of the patients had involvement of one lobe only (n = 12, 75%) while remaining patients had tumor extending into adjoining lobe (two lobe involvement) (n = 4, 25%). Temporal lobe was the most common site of involvement (n = 8, 50%) followed by frontal and parietal lobes (n = 2, 12.5% each). Among multilobular tumors, two patients had tumor located at fronto parietal lobe, one patient each had tumor located at the peritrigonal region (parieto-temporo-occipital junction) and anterior corpus callosum with bifrontal extension (6.2%). There were 14 (87.5%) peripheral tumors while two patients had deep tumors (12.5%). Both secondary GS was superficially located (100%) over the cerebral lobes while 12 out of 14 primary GS showed a peripheral location (85.7%). There was no evidence of calcification inside the tumor. One patient had radiological evidence of bleed inside it [Figure 1]. Average tumor size was 5.1 cm [range: 3–6 cm]. Majority (n = 12, 75%) of the tumors were totally solid (with or without necrotic areas) and four patients (25%) had large cystic component, two of whom had the appearance of mural nodule (12.5%). All lesions were hypo intense on T1, heterointense on T2 and enhanced variably on contrast. Enhancement was intense and homogenous in 7 (43.8%), intense but heterogenous in 4 (25%) and patchy/ring type enhancement was seen in five patients (31.2%) [Figures 2 and 3]. The wall of the cystic component also showed enhancement with contrast. Although majority of the tumors were peripherally located, dural tail sign was present only in four patients (25%). All patients had peritumoral edema and mass effect. All lesions were single, and there were no evidences of multifocality. Angiographic study was available in one patient who presented with intratumoral bleed. However, no abnormality was detected. Similar to the primary GS, secondary GS also showed inconsistent imaging findings. One of the patients with secondary GS had superficial dural-based mass with dural tail sign [Figure 4] while the second patient had a subcortical ill-defined mass with patchy enhancement [Figure 5].

Bottom Line: Patients with well-demarcated, enhancing mass on imaging intraoperatively had firm tumors with a good plane of cleavage and had a better survival (8 months) compared to those in whom the tumor radiologically and intraoperatively mimicked GBM (2 months).GS is associated with poor survival (median survival 6 months).While the former histologically mimics GBM and has very poor survival (2 months), GS with meningioma like feature tends to have better survival (8 months).

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Science, Lucknow, Uttar Pradesh, India.

ABSTRACT

Background: Gliosarcoma (GS), a subtype of glioblastoma (GBM), is a rare primary neoplasm of the central nervous system. Certain features like temporal lobe affinity, tendency for extraneural metastasis and poorer outcome compared to GBM indicate that GS may indeed be a separate clinicopathologic entity. This led us to revisit this entity in our settings.

Materials and methods: Between 2009 and 2014, 16 cases of histologically proven GSs (14 primary, two secondary) were treated. Patient data were retrieved retrospectively. Statistical analysis was performed with? Statistical Package for Social Sciences, version 17.0. (Chicago, Illinois, USA). Survival was analyzed by Kaplan-Meier method.

Results: GS predominantly affected males in their fifth decade of life. Raised intracranial pressure was the most common mode of clinical presentation. Temporal lobe was the most commonly affected part of the brain and majority of primary and all of secondary GBM were located peripherally. In 7 (43.8%) patients, tumor was radiologically well-demarcated and enhanced strongly and homogenously on contrast as compared to 9 (56.2%) patients where the tumor was ill-defined and showed heterogenous patchy or ring enhancement. Extent of excision was total in seven patients (43.8%), near total in 4 (25%) and subtotal in five patients (31.2%). Median survival was 6 months. Patients with well-demarcated, enhancing mass on imaging intraoperatively had firm tumors with a good plane of cleavage and had a better survival (8 months) compared to those in whom the tumor radiologically and intraoperatively mimicked GBM (2 months).

Conclusion: GS is associated with poor survival (median survival 6 months). Radiological and intraoperative findings help categorize these tumors into GBM like GS and meningioma like GS. While the former histologically mimics GBM and has very poor survival (2 months), GS with meningioma like feature tends to have better survival (8 months).

No MeSH data available.


Related in: MedlinePlus