Korean J Radiol.  2010 Oct;11(5):566-570. 10.3348/kjr.2010.11.5.566.

Gliosarcoma of the Cerebellar Hemisphere: a Case Report and Review of the Literature

• Moon SK
• Kim EJ
• Choi WS
• Ryu CW
• Park BJ
• Lee J

• KMID: 1102583
• DOI: http://doi.org/10.3348/kjr.2010.11.5.566

Abstract

Gliosarcoma is a rare central nervous system tumor usually located in the supratentorial area. Here we report a rare case of a gliosarcoma that developed in the cerebellar hemisphere in a 70-year-old woman. Computed tomography (CT) and magnetic resonance imaging (MRI) of the brain revealed an infratentorial mass of which radiological features were similar to those of glioblastoma. The tumor was diagnosed by pathology as a gliosarcoma. Though rare, gliosarcoma should be considered in the differential diagnosis of infratentorial tumors with radiological features of glioblastoma or metastasis in elderly patients.

Keyword

Gliosarcoma; Cerebellum; Posterior cranial fossa; Infratentorial tumor; Computed tomography (CT); Magnetic resonance imaging (MRI)

MeSH Terms

Aged
Cerebellar Neoplasms/*diagnosis/pathology/surgery
Contrast Media/diagnostic use
Female
Gliosarcoma/*diagnosis/pathology/surgery
Humans
Magnetic Resonance Imaging
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 70-year-old woman with gliosarcoma in right cerebellar hemisphere. A, B. Precontrast (A) and postcontrast (B) CT scans demonstrate right cerebellar mass with heterogeneous peripheral enhancement. C-E. Sagittal T1-weighted image (C) demonstrates well-defined hypointense mass, axial T2-weighted image (D) central hyperintense area, and post-contrast axial T1-weighted image (E) peripheral enhancement. F. This gradient echo image shows multiple dark signal foci in solid portion of mass, which indicate tumoral bleeding. G. This 18F-FDG-PET image shows increased metabolism in solid portion of tumor (arrow). H. Sarcomatous component consisted of densely packed spindle cells with nuclear atypia and frequent mitotic figures (Hematoxylin & Eosin staining, original magnification ×400). I, J. Gliomatous component, which was immunoreactive for glial fibrillary acid protein, intermingles with sarcomatous component (I: Hematoxylin & Eosin staining, J: immunohistochemistry; original magnification ×400). K. Abundant collagen fibers were found between individual tumor cells in sarcomatous component (Masson-trichrome; original magnification, ×400).

Reference

1. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007. 114:97–109.

2. Melo JR, Souza AL, Reis RC, Almeida MA. Infantile gliosarcoma. Arq Neuropsiquiatr. 2008. 66:88–89.

3. Nitta H, Hayase H, Moriyama Y, Yamashima T, Yamashita J. Gliosarcoma of the posterior cranial fossa: MRI findings. Neuroradiology. 1993. 35:279–280.

4. Kawaguchi S, Kashiwaba T, Koiwa M, Shimoyama M, Kobayashi N, Fukushi Y, et al. Two autopsied cases of radiation-induced gliosarcoma. No Shinkei Geka. 1991. 19:285–290. [Japanese].

5. Alatakis S, Stuckey S, Siu K, McLean C. Gliosarcoma with osteosarcomatous differentiation: review of radiological and pathological features. J Clin Neurosci. 2004. 11:650–656.

6. Malde R, Jalali R, Muzumdar D, Shet T, Kurkure P. Gliosarcoma occurring 8 years after treatment for a medulloblastoma. Childs Nerv Syst. 2004. 20:243–246.

7. Barresi V, Cerasoli S, Morigi F, Cremonini AM, Volpini M, Tuccari G. Gliosarcoma with features of osteoblastic osteosarcoma: a review. Arch Pathol Lab Med. 2006. 130:1208–1211.

8. Lieberman KA, Fuller CE, Caruso RD, Schelper RL. Postradiation gliosarcoma with osteosarcomatous components. Neuroradiology. 2001. 43:555–558.

9. Carstens PH, Johnson GS, Jelsma LF. Spinal gliosarcoma: a light, immunohistochemical and ultrastructural study. Ann Clin Lab Sci. 1995. 25:241–246.

10. Beaumont TL, Kupsky WJ, Barger GR, Sloan AE. Gliosarcoma with multiple extracranial metastases case report and review of the literature. J Neurooncol. 2007. 83:39–46.

11. Rodriguez FJ, Scheithauer BW, Jenkins R, Burger PC, Rudzinskiy P, Vlodavsky E, et al. Gliosarcoma arising in oligodendroglial tumors ("oligosarcoma"): a clinicopathologic study. Am J Surg Pathol. 2007. 31:351–362.

12. Rees JH, Smirniotopoulos JG, Jones RV, Wong K. Glioblastoma multiforme: radiologic-pathologic correlation. Radiographics. 1996. 16:1413–1438.

13. Witwer BP, Salamat MS, Resnick DK. Gliosarcoma metastatic to the cervical spinal cord: case report and review of the literature. Surg Neurol. 2000. 54:373–378.

14. Fischer S, Lee W, Aulisi E, Singh H. Gliosarcoma with intramedullary spinal metastases: a case report and review of the literature. J Clin Oncol. 2007. 25:447–449.

15. Demir MK, Hakan T, Akinci O, Berkman Z. Primary cerebellar glioblastoma multiforme. Diagn Interv Radiol. 2005. 11:83–86.

16. Mattos JP, Marenco HA, Campos JM, Faria AV, Queiroz LS, Borges G, et al. Cerebellar glioblastoma multiforme in an adult. Arq Neuropsiquiatr. 2006. 64:132–135.

17. Gupta V, Goyal A, Sinha S, Singh AK, Tatke M, Kumar S, et al. Glioblastoma of the cerebellum. A report of 3 cases. J Neurosurg Sci. 2003. 47:157–164.