Gliosarcomas: magnetic resonance imaging findings

Aya FUKUDA; Luciano de Souza QUEIROZ; Fabiano REIS

doi:10.1590/0004-282X20190158

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(02): 112-120
DOI: 10.1590/0004-282X20190158

View and Review

Gliosarcomas: magnetic resonance imaging findings

Gliossarcomas: achados de ressonância magnética

Aya FUKUDA

¹Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brazil.

,

Luciano de Souza QUEIROZ

²Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Anatomia Patológica, Campinas SP, Brazil.

,

Fabiano REIS

¹Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas SP, Brazil.

› Author Affiliations

Abstract

Background: Central nervous system (CNS) gliosarcoma (GSM) is a rare primary neoplasm characterized by the presence of glial and sarcomatous components. Objective: In this report, we describe the clinical and neuroimaging aspects of three cases of GSM and correlate these aspects with pathological findings. We also provide a brief review of relevant literature. Methods: Three patients were evaluated with magnetic resonance imaging (MRI), and biopsies confirmed the diagnosis of primary GSM, without previous radiotherapy. Results: The analysis of conventional sequences (T1, T1 after contrast injection, T2, Fluid attenuation inversion recovery, SWI and DWI/ADC map) and advanced (proton 1H MR spectroscopy and perfusion) revealed an irregular, necrotic aspect of the lesion, peritumoral edema/infiltration and isointensity of the solid component on a T2-weighted image. These features were associated with irregular and peripheral contrast enhancement, lipid and lactate peaks, increased choline and creatine levels in proton spectroscopy, increased relative cerebral blood volume (rCBV) in perfusion, multifocality and drop metastasis in one of the cases. Conclusion: These findings are discussed in relation to the general characteristics of GSM reported in the literature.

Resumo

Introdução: O gliossarcoma (GSM) do sistema nervoso central (SNC) é uma neoplasia primária rara, caracterizada pela presença de componentes gliais e sarcomatosos. Objetivo: Nosso objetivo é descrever os aspectos clínicos e de neuroimagem de três casos com este diagnóstico e correlacioná-los com os achados patológicos. Também foi realizada uma breve revisão da literatura relevante. Métodos: Três pacientes foram avaliados por ressonância magnética (RM), e biópsias confirmaram o diagnóstico de GSM primário, sem radioterapia prévia. Resultados: Foram analisadas as sequências convencionais (T1, T1 após injeção de contraste, T2, FLAIR-fluid attenuation inversion recovery, SWI, DWI/mapa ADC) e as sequências avançadas (espectroscopia de prótons 1H e perfusão), observando-se aspecto necrótico e irregular da lesão, edema/infiltração peritumoral, isointensidade do componente sólido em T2, associada a realce irregular e periférico pelo meio de contraste, pico de lípides e de lactato e aumento dos níveis de colina e creatina na espectroscopia de prótons, aumento do volume sanguíneo cerebral relativo (rCBV) na perfusão, multifocalidade e “drop” mestástase em um dos casos. Conclusão: O presente estudo descreve características do GSM, discutindo as informações na literatura científica, ilustrando algumas particularidades desses tumores.

Keywords:

brain neoplasms - gliosarcoma - immunohistochemistry - spectroscopy

Palavras-chave:

neoplasias encefálicas - gliossarcoma - imuno-histoquímica - espectroscopia

Full Text

References

References
1 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 Mar;31(3):351-62. https://doi.org/10.1097/01.pas.0000213378.94547.ae
2 Feigin IH, Gross SW. Sarcoma arising in glioblastoma of the brain. Am J Pathol. 1955 Aug;31(4):633-53.
3 Rubinstein LJ. The development of contiguous sarcomatous and gliomatous tissue in intracraneal tumors. J Pathol Bacteriol. 1956 Apr;71(2):441-59. https://doi.org/10.1002/path.1700710219
4 Schittenhelm J, Erdmann T, Maennlin S, Will BE, Beschorner R, Bornemann A, et al. Gliosarcoma with chondroid and osseous differentiation. Neuropathology. 2007 Feb;27(1):90-4. https://doi.org/10.1111/j.1440-1789.2006.00747.x
5 Kozak KR, Mahadevan A, Moody JS. Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol. 2009 Apr;11(2):183-91. https://doi.org/10.1215/15228517-2008-076
6 Morantz RA, Feigin I, Ransohoff J 3rd. Clinical and pathological study of 24 cases of gliosarcoma. J Neurosurg. 1976 Oct;45(4):398-408. https://doi.org/10.3171/jns.1976.45.4.0398
7 Slowik F, Jellinger K, Gaszó L, Fischer J. Gliosarcomas: histological, immunohistochemical, ultrastructural, and tissue culture studies. Acta Neuropathol. 1985;67(3-4):201-10. https://doi.org/10.1007/bf00687802
8 Actor B, Cobbers JM, Büschges R, Wolter M, Knobbe CB, Lichter P, et al. Comprehensive analysis of genomic alterations in gliosarcoma and its two tissue components. Genes Chromosomes Cancer. 2002 Aug;34(4):416-27. https://doi.org/10.1002/gcc.10087
9 Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016 Jun;131(6):803-20. https://doi.org/10.1007/s00401-016-1545-1
10 Romero-Rojas AE, Diaz-Perez JA, Amaro D, Lozano-Castillo A, Chinchilla-Olaya SI. Glioblastoma metastasis to parotid gland and neck lymph nodes: fine-needle aspiration cytology with histopathologic correlation. Head Neck Pathol. 2013 Dec;7(4):409-15. https://doi.org/10.1007/s12105-013-0448-x
11 Dawar R, Fabiano AJ, Qiu J, Khushalani NI. Secondary gliosarcoma with extra-cranial metastases: a report and review of the literature. Clin Neurol Neurosurg. 2013 Apr;115(4):375-80. https://doi.org/10.1016/j.clineuro.2012.06.017
12 Klitzke S, Schlittler LA, Lazaretti N, Villarroel RU, Dallagasperina VW, Azambuja N. Gliossarcoma: um desafio cliénico e terapeêutico. Rev AMRIGS. 2012 Jan/Mar;56(1):63-6.
13 Miller CR, Perry A. Glioblastoma. Arch Pathol Lab Med. 2007 Mar;131(3):397-406. https://doi.org/10.1043/1543-2165(2007)131[397:G]2.0.CO;2
14 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 Aug;130(8):1208-11. https://doi.org/10.1043/1543-2165(2006)130[1208:GWFOOO]2.0.CO;2
15 Karsy M, Gelbman M, Shah P, Balumbu O, Moy F, Arslan E. Established and emerging variants of glioblastoma multiforme: review of morphological and molecular features. Folia Neuropathol. 2012;50(4):301-21. https://doi.org/10.5114/fn.2012.32361
16 Romero-Rojas AE, Diaz-Perez JA, Ariza-Serrano LM, Amaro D, Lozano-Castillo A. Primary gliosarcoma of the brain: radiologic and histopathologic features. Neuroradiol J. 2013 Dec;26(6):639-48. https://doi.org/10.1177/197140091302600606
17 Osborn AG. Encéfalo Imagem, Patologia e Anatomia. Porto Alegre: Artmed; 2013. p. 489-90.
18 Pardo J, Murcia M, García F, Alvarado A. Gliosarcoma: a rare primary CNS tumor. Presentation of two cases. Rep Pract Oncol Radiother. 2010 Jul;15(4):98-102. https://doi.org/10.1016/j.rpor.2010.05.003
19 Lutterbach J, Guttenberger R, Pagenstecher A. Gliosarcoma: a clinical study. Radiother Oncol. 2001 Oct;61(1):57-64. https://doi.org/10.1016/S0167-8140(01)00415-7
20 Meis JM, Martz KL, Nelson JS. Mixed glioblastoma multiforme and sarcoma. A clinicopathologic study of 26 radiation therapy oncology group cases. Cancer. 1991 May;67(9):2342-9. https://doi.org/10.1002/1097-0142(19910501)67:9%3C2342::aid-cncr2820670922%3E3.0.co;2-b
21 Salvati M, Caroli E, Raco A, Giangaspero F, Delfini R, Ferrante L. Gliosarcomas: analysis of 11 cases. Do two subtypes exist? J Neurooncol. 2005 Aug;74(1):59-63. https://doi.org/10.1007/s11060-004-5949-8
22 Galanis E, Buckner JC, Dinapoli RP, Scheithauer BW, Jenkins RB, Wang CH, et al. Clinical outcome of gliosarcoma compared with glioblastoma multiforme: North Central Cancer Treatment Group results. J Neurosurg. 1998 Sep;89(3):425-30. https://doi.org/10.3171/jns.1998.89.3.0425
23 Sarkar C, Sharma MC, Sudha K, Gaikwad S, Varma A. A clinico-pathological study of 29 cases of gliosarcoma with special reference to two unique variants. Indian J Med Res. 1997 Sep;106:229-35.
24 Perry JR, Ang LC, Bilbao JM, Muller PJ. Clinicopathologic features of primary and post irradiation cerebral gliosarcoma. Cancer. 1995 Jun;75(12):2910-8. https://doi.org/10.1002/1097-0142(19950615)75:12%3C2910::aid-cncr2820751219%3E3.0.co;2-a
25 Parekh HC, O’Donovan DG, Sharma RR, Keogh AJ. Primary cerebral gliosarcoma: report of 17 cases. Br J Neurosurg. 1995 Apr;9(2):171-8. https://doi.org/10.1080/02688699550041511
26 Fukuda T, Yasumichi K, Suzuki T. Immunohistochemistry of gliosarcoma with liposarcomatous differentiation. Pathol Int. 2008 Jun;58(6):396-401. https://doi.org/10.1111/j.1440-1827.2008.02242.x
27 Yi X, Cao H, Tang H, Gong G, Hu Z, Liao W, et al. Gliosarcoma: a clinical and radiological analysis of 48 cases. Eur Radiol. 2019 Jan;29(1):429-38. https://doi.org/10.1007/s00330-018-5398-y
28 Moon SK, Kim EJ, Choi WS, Ryu CW, Park BJ, Lee J. Gliosarcoma of the cerebellar hemisphere: a case report and review of the literature. Korean J Radiol. 2010 Sep/Oct;11(5):566-70. https://doi.org/10.3348/kjr.2010.11.5.566
29 Rees JH, Smirniotopoulos JG, Jones RV, Wong K. Glioblastoma multiforme: radiologic-pathologic correlation. Radiographics. 1996 Nov;16(6):1413-38. https://doi.org/10.1148/radiographics.16.6.8946545
30 Romeike BF, Chen Y, Walter J, Petersen I. Diagnostic utility of IDH1- and p53-mutation analysis in secondary gliosarcoma. Clin Neuropathol. 2011 Sep/Oct;30(5):231-4. https://doi.org/10.5414/np300375
31 Kumar N, Bhattacharyya T, Chanchalani K, et al. Impact of changing trends of treatment on outcome of cerebral gliosarcoma: a tertiary care centre experience. South Asian J Cancer. 2015 Jan/Mar;4(1):15-17. https://doi.org/10.4103/2278-330X.149931
32 Mason WP, Del Maestro R, Eisenstat D, Forsyth P, Fulton D, Laperrière N, et al. Canadian recommendations for the treatment of glioblastoma multiforme. Curr Oncol. 2007 Jun;14(3):110-117. https://doi.org/10.3747/co.2007.119
33 Salcman M. Survival in glioblastoma: historical perspective. Neurosurgery. 1980 Nov;7(5):435-9. https://doi.org/10.1227/00006123-198011000-00001
34 di Norcia V, Piccirilli M, Giangaspero F, Salvati M. Gliosarcomas in the elderly: analysis of 7 cases and clinico-pathological remarks. Tumori. 2008 Jul/Aug; 94(4):493-6.
35 Machuca TN, Prevedello DM, Pope LZ, Haratz SS, Araújo JC, Torres LF. Gliosarcoma: Report of four cases with immunohistochemical findings. Arq Neuropsiquiatr. 2004 Sep;62(3A):608-12. https://doi.org/10.1590/s0004-282x2004000400008
36 Lucena RCG, Mello RJV, Lessa Jr. JR, Cavalcante GM, Ribeiro M. Correlação clínico-topográfica em glioblastomas multiformes nas síndromes motoras. Arq Neuropsiquiatr. 2006 Jun;64(2-B):441-5. http://dx.doi.org/10.1590/S0004-282X2006000300017
37 Meis JM, Ho KL, Nelson JS. Gliosarcoma: a histologic and immunohistochemical reaffirmation. Mod Pathol. 1990 Jan;3(1):19-24.
38 Moreira RK, Koppe D, Zignani J, Marconato MC, Abreu M, Pitrez E. Gliossarcoma de tronco cerebral em paciente pediátrico: relato de caso. Radiol Bras. 2004;37(1):61-63. http://dx.doi.org/10.1590/S0100-39842004000100013
39 Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009 Jan;45(2):228-47. https://doi.org/10.1016/j.ejca.2008.10.026
40 Huo Z, Yang D, Shen J, Li Y, Wu H, Meng Y, et al. Primary gliosarcoma with long-survival: report of two cases and review of literature. Int J Clin Exp Pathol. 2014 Aug;7(9):6323-32.
41 Peckham ME, Osborn AG, Palmer CA, Tsai A, Salzman KL. Gliosarcoma: neuroimaging and immunohistochemical findings. J Neuroimaging. 2019 Jan;29(1):126-32. https://doi.org/10.1111/jon.12565
42 Hsieh JK, Hong CS, Manjila S, Cohen ML, Lo S, Rogers L, et al. An IDH1-mutated primary gliosarcoma: case report. J Neurosurg. 2017 Feb;126(2):476-80. https://doi.org/10.3171/2016.2.JNS151482
43 Cambruzzi E. The role of IDH1/2 mutations in the pathogenesis of secondary glioblastomas. J Bras Patol Med Lab. 2017 Sep/Oct;53(5):338-44. http://dx.doi.org/10.5935/1676-2444.20170055
44 Lee D, Kang SY, Suh YL, Jeong JY, Lee JI, Nam DH. Clinicopathologic and genomic features of gliosarcomas. J Neurooncol. 2012 May;107(3):643-50. https://doi.org/10.1007/s11060-011-0790-3
45 Meena US, Sharma S, Chopra S, Jain SK. Gliosarcoma: A rare variant of glioblastoma multiforme in paediatric patient: Case report and review of literature. World J Clin Cases. 2016 Sep;4(9):302-05. https://doi.org/10.12998/wjcc.v4.i9.302
46 Zhang BY, Chen H, Geng DY, Yin B, Li YX, Zhong P, et al. Computed tomography and magnetic resonance features of gliosarcoma: a study of 54 cases. J Comput Assist Tomogr. 2011 Nov/Dec;35(6):667-73. https://doi.org/10.1097/RCT.0b013e3182331128
47 Swaidan MY, Hussaini M, Sultan I, Mansour A. Radiological findings in gliosarcoma - A single institution experience. Neuroradiol J. 2012 May;25(2):173-80. https://doi.org/10.1177/197140091202500203
48 Lin JN, Chiang IC, Tsai TC, et al. 3T-Magnetic resonance imaging and proton magnetic resonance spectroscopy findings in gliosarcoma: a case report. Chin J Radiol. 2007;32:81-5.
49 Han L, Zhang X, Qiu S, Li X, Xiong W, Zhang Y, et al. Magnetic resonance imaging of primary cerebral gliosarcoma: a report of 15 cases. Acta Radiolog. 2008;49(9):1058-67.
50 Sampaio L, Linhares P, Fonseca J. Detailed magnetic resonance imaging features of a case series of primary gliosarcoma. Neuroradiol J. 2017 Dec;30(6):546-53. https://doi.org/10.1177/1971400917715879
51 Law M, Yang S, Wang H, Babb JS, Johnson G, Cha S, et al. Glioma grading: sensitivity, specificity, and predictive values of perfusion MR imaging and proton MR spectroscopic imaging compared with conventional MR imaging. AJNR Am J Neuroradiol. 2003 Nov/Dec;24(10):1989-98.
52 Stadlbauer A, Gruber S, Nimsky C, Fahlbusch R, Hammen T, Buslei R, et al. Preoperative grading of gliomas by using metabolite quantification with high-spatial-resolution proton MR spectroscopic imaging. Radiology. 2006 Mar;238(3):958-69. https://doi.org/10.1148/radiol.2382041896
53 Raab P, Pilatus U, Hattingen E, Franz K, Hermann E, Zanella FE, et al. Spectroscopic characterization of gliosarcomas - Do they differ from glioblastomas and metastases? J Comput Assist Tomogr. 2016 Sep/Oct;40(5):815-9. https://doi.org/10.1097/RCT.20190158201901580419
54 Yamasaki F, Takaba J, Ohtaki M, Abe N, Kajiwara Y, Saito T, et al. Detection and differentiation of lactate and lipids by single-voxel proton MR spectroscopy. Neurosurg Rev. 2005;28(4):267-77. https://doi.org/10.1007/s10143-005-0398-1
55 Ramos R, Morais N, Silva AI, Almeida R. Gliosarcoma with neuroaxis metastases. BMJ Case Rep. 2015 Oct;2015:bcr2015212970. http://dx.doi.org/10.1136/bcr-2015-212970