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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

(a) Tumor disposed in sheets showing pleomorphic cells displaying anisomorphic nuclei, frequent mitosis (H and E, ×100). Areas of spindle tumor cells displaying anisonucleosis are also noted (b) (H and E, ×200). Foci of reticulin-rich tumor cells (c: Reticulin, ×40) suggest sarcomatous component. Glial fibrillary acidic protein (GFAP) positive tumor cells seen in glial component and interspersed glial GFAP negative tumor cells suggest sarcomatous component (d and e: GFAP, ×200)
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Figure 6: (a) Tumor disposed in sheets showing pleomorphic cells displaying anisomorphic nuclei, frequent mitosis (H and E, ×100). Areas of spindle tumor cells displaying anisonucleosis are also noted (b) (H and E, ×200). Foci of reticulin-rich tumor cells (c: Reticulin, ×40) suggest sarcomatous component. Glial fibrillary acidic protein (GFAP) positive tumor cells seen in glial component and interspersed glial GFAP negative tumor cells suggest sarcomatous component (d and e: GFAP, ×200)

Mentions: Pathologically, all patients showed a biphasic tumor, consisting of malignant gliomatous (Grade 4) areas admixed with sarcomatous areas showing a mostly spindle cell pattern. The gliomatous component displayed features of GBM with areas of necrosis, vascular proliferation, and stained avidly with GFAP. On the other hand, sarcomatous component was composed of spindle-shaped cells that failed to stain with GFAP [Figure 6]. Microscopic evidence of calcification was present in one patient. Two patients had myxoid degeneration of the sarcomatous area. Tumor giant cells were present in almost all of the patients (n = 15). Microscopic evidence of intratumoral hemorrhage was seen in two patients. Histology in one patient showed undifferentiated areas in addition to the gliomatous and sarcomatous components. Both patients of secondary GS developed sarcomatous change after 2 years of surgical resection of GBMs and chemoradiotherapy. Both patients had GBMs affecting temporal lobes and were located peripherally abutting dura. Histologically, they were indistinguishable from primary GS. We reviewed the histopathology reports to find out if there was any histological difference between the two groups (Group A and B). Although information regarding quantitative analysis of each component was not available in the reports, Group A (n = 7, 43.8%) revealed prominent areas of spindle cells with robust reticulin positivity interspersed with GFAP positive GBMs component. While Group B (n = 9, 56.3%) showed an abundance of strong GFAP staining cells with few often peripherally dispersed reticulin rich spindle cells. Hence, it appeared that the predominance of sarcomatous component imparted a meningioma like feature to a GS.


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)

(a) Tumor disposed in sheets showing pleomorphic cells displaying anisomorphic nuclei, frequent mitosis (H and E, ×100). Areas of spindle tumor cells displaying anisonucleosis are also noted (b) (H and E, ×200). Foci of reticulin-rich tumor cells (c: Reticulin, ×40) suggest sarcomatous component. Glial fibrillary acidic protein (GFAP) positive tumor cells seen in glial component and interspersed glial GFAP negative tumor cells suggest sarcomatous component (d and e: GFAP, ×200)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: (a) Tumor disposed in sheets showing pleomorphic cells displaying anisomorphic nuclei, frequent mitosis (H and E, ×100). Areas of spindle tumor cells displaying anisonucleosis are also noted (b) (H and E, ×200). Foci of reticulin-rich tumor cells (c: Reticulin, ×40) suggest sarcomatous component. Glial fibrillary acidic protein (GFAP) positive tumor cells seen in glial component and interspersed glial GFAP negative tumor cells suggest sarcomatous component (d and e: GFAP, ×200)
Mentions: Pathologically, all patients showed a biphasic tumor, consisting of malignant gliomatous (Grade 4) areas admixed with sarcomatous areas showing a mostly spindle cell pattern. The gliomatous component displayed features of GBM with areas of necrosis, vascular proliferation, and stained avidly with GFAP. On the other hand, sarcomatous component was composed of spindle-shaped cells that failed to stain with GFAP [Figure 6]. Microscopic evidence of calcification was present in one patient. Two patients had myxoid degeneration of the sarcomatous area. Tumor giant cells were present in almost all of the patients (n = 15). Microscopic evidence of intratumoral hemorrhage was seen in two patients. Histology in one patient showed undifferentiated areas in addition to the gliomatous and sarcomatous components. Both patients of secondary GS developed sarcomatous change after 2 years of surgical resection of GBMs and chemoradiotherapy. Both patients had GBMs affecting temporal lobes and were located peripherally abutting dura. Histologically, they were indistinguishable from primary GS. We reviewed the histopathology reports to find out if there was any histological difference between the two groups (Group A and B). Although information regarding quantitative analysis of each component was not available in the reports, Group A (n = 7, 43.8%) revealed prominent areas of spindle cells with robust reticulin positivity interspersed with GFAP positive GBMs component. While Group B (n = 9, 56.3%) showed an abundance of strong GFAP staining cells with few often peripherally dispersed reticulin rich spindle cells. Hence, it appeared that the predominance of sarcomatous component imparted a meningioma like feature to a GS.

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