Gliosarcoma

Case contributed by Dr Henry Knipe

Presentation

Headaches, confusion and aphasia.

Patient Data

Age: 50
Gender: Male
Modality: CT

There is a rim enhancing fluid density mass lesion present within the left frontal lobe with mass effect, and midline shift to the right of up to 1 cm. Associated with the wall of the mass lesion there is a nodular component. Oedema is present within the adjacent left frontal lobe.

A further enhancing mass lesion is present within the left parietal lobe. This is causing effacement of the occipital horn of the left lateral ventricle. This demonstrates rim enhancement with a heterogenous centre. There is effacement of the adjacent cortical sulcal and gyral pattern.

MRI Brain

Modality: MRI

Multifocal areas of abnormality. In the left frontal lobe there is a cystic cavity with linear peripheral enhancement which is thick medially with surrounding oedema.

There is an infiltrative mass encasing the occipital horn of the left lateral ventricle, crossing the splenium of the corpus callosum, extending into the left temporal lobe and into the left cerebral peduncle. There is a necrotic enhancing area demonstrating thick peripheral enhancement in the posterior temporal region.

There is mass-effect with 9 mm midline shift, distortion of the brainstem and effacement of the cortical sulci.

MICROSCOPIC DESCRIPTION: 1&2. Paraffin sections show fragments of a densely hypercellular tumour. This consists of a vesicular arrangement of markedly pleomorphic spindle cells which enclose aggregates of cells which have a more epithelioid morphology. These have pleomorphic vesicular nuclei and a variable amount of pale cytoplasm. Frequent mitotic figures are identified. Vessels are prominent in many areas of the tumour and there is multilayering of atypical cells around vessel lumena. There are also several small foci of necrosis.

DIAGNOSIS: 1&2. Left frontal brain tumour: Gliosarcoma (WHO Grade IV).

Case Discussion

Gliosarcomas are rare, highly malignant primary brain tumours with both glial and mesenchymal elements. 

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Case Information

rID: 39150
Case created: 21st Aug 2015
Last edited: 31st Aug 2015
Inclusion in quiz mode: Included

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