Gliosarcomas, a Review of Clinicopathological Features of a Series of 28 Cases – An Institutional Experience.
Sridhar Epari, Sharique Ahmed, Vivek Tiwari, Aliasgar Moiyadi, Rakesh Jalali, Prakash Shetty, Tejpal Gupta, Munita Bal, Shubhada Kane. Tata Memorial Centre, Mumbai, Maharastra, India
Background: Gliosarcomas (GS) are rare WHO grade IV primary biphasic brain tumours composed of high grade glial and mesenchymal components.
Design: Achives of the departmental files of the last five years were reviewed and cases of gliosarcoma, where paraffin blocks and reasonable clinical information were available were included.
Results: Total number of 28 cases with age range of 32-70 yrs (median: 50yrs and mean: 51 yrs) and sex ratio: 3:1(M- 24; F-4) were noted. The location of these tumours were predominantly cerebral hemispheric with commonest being temporal (n-11). Other sites are – frontal: 9 (including one case of frontoparietal), parietal: 4, occipital:2, hippocampal with a predominant intraventricular:1 and posterior fossa :1 (predominant component is in cerebellopontine [CP] angle). One case each occurred in treated patients of medulloblastoma and adenoid cystic carcinoma of lip. Histologically, all except for one case showed an intricate admixture of glial and mesenchymal components. One case (known treated case of adenoid cystic carcinoma) showed a predominantly sarcomatous component with very scant (<5%) glial component. In six of the cases, the sarcomatous component showed myogenic differentiation (smooth muscle actin and calponin, both positive), one case showed chondrosarcomatous differentiation and in rest of the cases the differentiation of the sarcomatous component could not be made. Additionally, three cases showed admixed population of small undifferentiated small cell component (Mic-2 was negative in all of these cases). In two of the cases, an epithelioid morphology was noted (both epithelial membrane antigen and pancytokeratin were negative). p53 protein immunopositivity was noted in 26 cases; it was negative in two cases (one of which showed round cell component). MIB-1 labeling index (LI) was variable 15-40% (10-20% -22, 20-30% -3 and 30-40% – 3). One case showed extracranial metastasis (p53 negative, comprising a component of undifferentiated small cells) to iliac bone.
Conclusions: GS are rare primary brain tumours, this series documents the occurrence at rare sites (in intraventricular and CP angle), as second primary tumours in a previously diagnosed unrelated malignancies, heterogeneity of dedifferentiation (undifferentiated, myogenic and rare matrix producing chondrosarcomatous) and their potential for extracranial metastases.
Tuesday, March 1, 2011 2:15 PM
Platform Session: Section G, Tuesday Afternoon