Hostname: page-component-745bb68f8f-hvd4g Total loading time: 0 Render date: 2025-01-13T01:32:00.475Z Has data issue: false hasContentIssue false
  • English
  • Français

Unusual Evolution and Computerized Tomographic Appearance of a Gliosarcoma

Published online by Cambridge University Press:  18 September 2015

Mark C. Preul ,
Jose A. Espinosa ,
Donatella Tampieri  and
Stirling Carpenter
Mark C. Preul
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
Jose A. Espinosa
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
Donatella Tampieri*
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
Stirling Carpenter
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
*
Division of Neuroradiology, Montreal Neurological Hospital, 3801 University Street, Montreal. PQ, Canada H3A 2B4
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

A patient with a remote infarct, seizures, mild hemiparesis, and dysphasia became obtunded over four months and died. Computerized tomography (CT) over 5 years showed a consistent, large, wedge-shaped left hemisphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cerebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspect that the unusual CT appearance of the lesion was likely caused by multiple pathologies: a low grade glioma transforming into a gliosarcoma that was able to spread throughout the area of infarct encephalomalacia without revealing a typical CT appearance of mass effect. The patient's brief period of deterioration probably coincided with transformation of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.

Résumé:

RÉSUMÉ:

Un patient présentant un infarctus ancien, des convulsions, une légère hémiparésie et une dysphasie, a développé de la confusion quatre mois avant son décès. La tomodensitométrie sériée sur 5 ans a montré une zone étendue, de forme triangulaire, hypodense, sans calcification centrale, mais sans aspect de masse, à l'hémisphère gauche. Cette image a été interprétée comme étant un infarctus dans le territoire de l'artère cérébrale moyenne. L'autopsie du cerveau a révélé que toute la zone qui avait l'apparence d'un infarctus à la tomodensitométrie était en fait un gliosarcome. Nous soupçonnons que l'aspect inhabituel de la lésion à la tomodensitométrie était dû à des pathologies multiples: un gliome évoluant à bas bruit qui s'est transformé en gliosarcome et qui a envahi la zone d'encéphalomalacie post-infarctus, sans produire d'aspect de masse à la tomodensitométrie. La détérioration rapide du patient a probablement coïncidé avec la transformation de la tumeur en gliosarcome. Nous revoyons les caractéristiques tomodensitométriques variables des gliosarcomes.

Type
Articles
Information
Canadian Journal of Neurological Sciences , Volume 21 , Issue 2 , May 1994 , pp. 141 - 145
Copyright
Copyright © Canadian Neurological Sciences Federation 1994

References

REFERENCES

1. Feigin, IH, Allen, LB, Lipkin, L. The endothelial hyperplasia of the cerebral blood vessels with brain tumors and its sarcomatous transformation. Cancer 1958; 11: 264–277.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
2. Feigin, IH, Gross, SW. Sarcoma arising in glioblastoma of the brain. Am J Pathol 1955; 31: 633–653.Google ScholarPubMed
3. Morantz, RA, Feigin, I, Ransohoff, J. Clinical and pathological study of 24 cases of gliosarcoma. J Neurosurg 1976; 45: 398–408.CrossRefGoogle ScholarPubMed
4. Wislowski, J. Gliosarcoma tumors with a sarcomatous neurogliosarcoma and glioma multiforme in a neoplastic area. Neuropathol Pol 1970; 8: 23–28.Google Scholar
5. Smith, DR, Hardman, JM, Earle, KM. Contiguous glioblastoma multiforme and fibrosarcoma with extracranial metastasis. Cancer 1969; 24: 270–276.3.0.CO;2-5>CrossRefGoogle ScholarPubMed
6. Goldman, RL. Gliomyosarcoma of the cerebrum. Am J Clin Pathol 1969; 52: 741–744.CrossRefGoogle ScholarPubMed
7. Greene, HSN, Harvey, EK. The development of sarcomas from transplants of the hyperplastic stromal endothelium of glioblastoma multiforme. Am J Pathol 1968; 53: 483–499.Google ScholarPubMed
8. Lee, Y-Y, Castillo, M, Nauert, C, Moser, RP. Computed tomography of gliosarcoma. Am J Neuroradiol 1985; 6: 527–531.Google ScholarPubMed
9. Maiuri, F, Stella, L, Benvenuti, D, Giamundo, A, Pettinato, G. Cerebral gliosarcomas: correlation of computed tomographic findings, surgical aspect, pathological features, and prognosis. Neurosurgery 1990; 26: 261–267.CrossRefGoogle ScholarPubMed
10. Meis, JM, Martz, KL, Nelson, JS. Mixed glioblastoma multiforme and sarcoma. A clinicopathologic study of 26 radiation therapy oncology group cases. Cancer 1991; 67: 2342–2349.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
11. French, JD. Astroblastoma and perithelial sarcoma in a case of neoplastic disease of the brain. J Neuropathol Exp Neurol 1949; 8: 232–239.CrossRefGoogle Scholar
12. Stroebe, H. Uber Entstehung und Bau der Gehirngliome. Beitr Pathol 1895; 18:405–486.Google Scholar
13. Schiffer, D, Giordana, MT, Mauro, A, Migheli, A. GFAP, F VIII/RAg, laminin, ftbronectin in glioscarcomas: an immunohistochemical study. Acta Neuropathol 1984; 63: 108–116.CrossRefGoogle Scholar
14. Slowik, F, Jellinger, K, Gas zo, L, Fischer, J. Gliosarcomas: histological, immunohistochemical, ultrastructural, and tissue culture studies. Acta Neuropathol 1985; 67: 201–210.CrossRefGoogle ScholarPubMed
15. Lalitha, VS, Rubinstein, LI. Reactive glioma in intracranial sarcoma: a form of mixed sarcoma and glioma (“sarcoglioma”). Cancer 1979; 43: 246–257.3.0.CO;2-J>CrossRefGoogle Scholar
16. Goldstein, SJ, Young, B, Markesberry, WR. Congenital malignant gliosarcoma. Am J Neuroradiol 1981; 2: 475–476.Google ScholarPubMed
17. Jack, CR, Bhansali, DT, Chason, JL, et al. Angiographic features of gliosarcoma. Am J Neuroradiol 1987; 8: 117–122.Google ScholarPubMed