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Gliosarcoma with multiple extracranial metastases: case report and review of the literature

  • Clinical–Patient Studies
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Abstract

Gliosarcoma is a rare malignant neoplasm of the central nervous system with a propensity for metastasis. There are fewer than 20 reported cases of extracranial metastases of gliosarcoma with the majority of cases reflecting a tendency for hematogenous dissemination. Here we describe the case of a 47-year-old man who developed pervasive extracranial metastases from a temporal gliosarcoma following radio- and chemotherapy for a primary glioblastoma. The patient initially presented with progressively worsening headaches, left-sided weakness and numbness associated with right temporo-parietal mass for which he underwent craniotomy with stereotactic gross-total excision. Two months postoperatively, interstitial brachytherapy and external beam radiotherapy were initiated. The patient initially declined chemotherapy. The tumor recurred twice and the patient underwent re-operation and multiple courses of chemotherapy; histopathological diagnosis remained glioblastoma multiforme. Nineteen months following initial resection the patient’s clinical status deteriorated and CT scan demonstrated multiple intrathoracic, hepatic and splenic lesions. Postmortem examination revealed widespread, infiltrating gliosarcoma with intravascular gliomatosis and extensive visceral metastases. This is the first report of pervasive extracranial metastases to numersous sites, several of which have not been previously reported. The histogenesis and the potential role of therapeutic irradiation in the development of gliosarcoma are briefly reviewed.

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References

  1. Albrecht S, Connelly JH, Bruner JM (1993) Distribution of p53 protein expression in gliosarcomas: an immunohistochemical study. Acta Neuropathol (Berl) 85:222–226

    CAS  Google Scholar 

  2. Averback P (1978) Mixed intracranial sarcomas: rare forms and a new association with previous radiation therapy. Ann Neurol 4:229–233

    Article  PubMed  CAS  Google Scholar 

  3. Banerjee AK, Sharma BS, Kak VK et al (1989) Gliosarcoma with cartilage formation. Cancer 63:518–523

    Article  PubMed  CAS  Google Scholar 

  4. Barnard RO, Bradford R, Scott T et al (1986) Gliomyosarcoma. Report of a case of rhabdomyosarcoma arising in a malignant glioma. Acta Neuropathol (Berl) 69:23–27

    Article  CAS  Google Scholar 

  5. Beute BJ, Fobben ES, Hubschmann O et al (1991) Cerebellar gliosarcoma: report of a probable radiation-induced neoplasm. AJNR Am J Neuroradiol 12:554–556

    PubMed  CAS  Google Scholar 

  6. Biernat W, Aguzzi A, Sure U et al (1995) Identical mutations of the p53 tumor suppressor gene in the gliomatous and the sarcomatous components of gliosarcomas suggest a common origin from glial cells. J Neuropathol Exp Neurol 54:651–656

    PubMed  CAS  Google Scholar 

  7. Boerman RH, Anderl K, Herath J et al (1996) The glial and mesenchymal elements of gliosarcomas share similar genetic alterations. J Neuropathol Exp Neurol 55:973–981

    PubMed  CAS  Google Scholar 

  8. Cerame MA, Guthikonda M, Kohli CM (1985) Extraneural metastases in gliosarcoma: a case report and review of the literature. Neurosurgery 17:413–418

    Article  PubMed  CAS  Google Scholar 

  9. Ehrenreich T, Devlin JF (1958) A complex of glioblastoma and spindle-cell sarcoma with pulmonary metastases. Arch Pathol 66:536–549

    Google Scholar 

  10. Feigin IH, Gross SW (1955) Sarcoma arising in glioblastoma of the brain. Am J Pathol 31:633–653

    Google Scholar 

  11. Fontana M, Stanton C, Pompili A et al (1987) Late multifocal gliomas in adolescents previously treated for acute lymphoblastic leukemia. Cancer 60:1510–1518

    Article  PubMed  CAS  Google Scholar 

  12. Friedman HS, Petros WP, Friedman AH et al (1999) Irinotecan therapy in adults with recurrent or progressive malignant glioma. J Clin Oncol 17:1516–1525

    PubMed  CAS  Google Scholar 

  13. Galanis E, Buckner JC, Dinapoli RP et al (1998) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: North Central Cancer Treatment Group results. J Neurosurg 89:425–430

    Article  PubMed  CAS  Google Scholar 

  14. Garret R (1958) Glioblastoma and fibrosarcoma of the brain with extracranial metaastases. Cancer Phil 11:888–894

    Article  CAS  Google Scholar 

  15. Gjerdrum LM, Bojsen-Moller M (1999) October 1998–61-year-old male with brain tumor and oral, lung, and palpebral masses. Brain Pathol 9:421–422

    PubMed  CAS  Google Scholar 

  16. Haddad SF, Moore SA, Schelper RL et al (1992) Smooth muscle can comprise the sarcomatous component of gliosarcomas. J Neuropathol Exp Neurol 51:493–498

    PubMed  CAS  Google Scholar 

  17. Kaschten B, Flandroy P, Reznik M et al (1995) Radiation-induced gliosarcoma. Case report and review of the literature. J Neurosurg 83:154–162

    PubMed  CAS  Google Scholar 

  18. Kattar MM, Kupsky WJ, Shimoyama RK et al (1997) Clonal analysis of gliomas. Hum Pathol 28:1166–1179

    Article  PubMed  CAS  Google Scholar 

  19. Kepes JJ, Bastian FO, Weber ED (1996) Gliosarcoma developing from an irradiated ependymoma. Acta Neuropathol (Berl) 92:515–519

    Article  CAS  Google Scholar 

  20. Kleihues P, Burger PC, Scheithauer BW (1993) The new WHO classification of brain tumours. Brain Pathol 3:255–268

    PubMed  CAS  Google Scholar 

  21. Lieberman KA, Fuller CE, Caruso RD et al (2001) Postradiation gliosarcoma with osteosarcomatous components. Neuroradiology 43:555–558

    Article  PubMed  CAS  Google Scholar 

  22. Matsuyama J, Mori T, Hori S et al (1989) [Gliosarcoma with multiple extracranial metastases. Case report]. Neurol Med Chir (Tokyo) 29:938–943

    Article  CAS  Google Scholar 

  23. Meis JM, Martz KL, Nelson JS (1991) Mixed glioblastoma multiforme and sarcoma. A clinicopathologic study of 26 radiation therapy oncology group cases. Cancer 67:2342–2349

    Article  PubMed  CAS  Google Scholar 

  24. Morantz RA, Feigin I, Ransohoff J III (1976) Clinical and pathological study of 24 cases of gliosarcoma. J Neurosurg 45:398–408

    PubMed  CAS  Google Scholar 

  25. Ojeda VJ, Sterrett GF (1984) Cerebral gliosarcoma, pulmonary adenoid–cystic carcinoma, and pulmonary metastatic gliosarcoma: report of an untreated case. Pathology 16:217–221

    PubMed  CAS  Google Scholar 

  26. Paulus W, Bayas A, Ott G et al (1994) Interphase cytogenetics of glioblastoma and gliosarcoma. Acta Neuropathol (Berl) 88:420–425

    CAS  Google Scholar 

  27. Perry JR, Ang LC, Bilbao JM et al (1995) Clinicopathologic features of primary and postirradiation cerebral gliosarcoma. Cancer 75:2910–2918

    Article  PubMed  CAS  Google Scholar 

  28. Reis RM, Konu-Lebleblicioglu D, Lopes JM et al (2000) Genetic profile of gliosarcomas. Am J Pathol 156:425–432

    PubMed  CAS  Google Scholar 

  29. Rimm IJ, Li FC, Tarbell NJ et al (1987) Brain tumors after cranial irradiation for childhood acute lymphoblastic leukemia. A 13-year experience from the Dana-Farber Cancer Institute and the Children’s Hospital. Cancer 59:1506–1508

    Article  PubMed  CAS  Google Scholar 

  30. Schrantz JL, Araoz CA (1972) Radiation-induced meningeal fibrosarcoma. Arch Pathol 93:26–31

    PubMed  CAS  Google Scholar 

  31. Slowik F, Balogh I (1980) Extracranial spreading of glioblastoma multiforme. Zentralbl Neurochir 41:57–68

    PubMed  CAS  Google Scholar 

  32. Slowik F, Jellinger K, Gaszo L et al (1985) Gliosarcomas: histological, immunohistochemical, ultrastructural, and tissue culture studies. Acta Neuropathol (Berl) 67:201–210

    Article  CAS  Google Scholar 

  33. Smith DR, Hardman JM, Earle KM (1969) Contiguous glioblastoma multiforme and fibrosarcoma with extracranial metastasis. Cancer 24:270–276

    Article  PubMed  CAS  Google Scholar 

  34. Strobe H (1895) Ueber entstehung und bau der gehirnglioma. Beitr Pathol Anat Allg Pathol 18:405–486

    Google Scholar 

  35. Walter AW, Hancock ML, Pui CH et al (1998) Secondary brain tumors in children treated for acute lymphoblastic leukemia at St Jude Children’s Research Hospital. J Clin Oncol 16:3761–3767

    PubMed  CAS  Google Scholar 

  36. Weaver D, Vandenberg S, Park TS et al (1984) Selective peripancreatic sarcoma metastases from primary gliosarcoma. Case report. J Neurosurg 61:599–601

    Article  PubMed  CAS  Google Scholar 

  37. Weiss L (1955) A metastasizing ependymomoa of the cauda equina. Cancer 8:161–171

    Article  PubMed  CAS  Google Scholar 

  38. Wharton SB, Whittle IR, Collie DA et al (2001) Gliosarcoma with areas of primitive neuroepithelial differentiation and extracranial metastasis. Clin Neuropathol 20:212–218

    PubMed  CAS  Google Scholar 

  39. Witwer BP, Salamat MS, Resnick DK (2000) Gliosarcoma metastatic to the cervical spinal cord: case report and review of the literature. Surg Neurol 54:373–378; discussion 378–379

    Google Scholar 

  40. Yokoyama H, Ono H, Mori K et al (1985) Extracranial metastasis of glioblastoma with sarcomatous component. Surg Neurol 24:641–645

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We thank Dr. Bradley McCollum for his assistance with the imaging of the pathological specimens and Drs. Marc Chamberlain and Richard Rhiew for their helpful discussions and critical review of the manuscript. We also thank Dr. Otto Muzik for compiling the PET data. AES was supported in part by a grant from the NCI (CA101954).

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Authors and Affiliations

  1. Department of Neurosurgery, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA

    Thomas L. Beaumont & Andrew E. Sloan

  2. Department of Neurology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA

    William J. Kupsky & Geoffrey R. Barger

  3. Department of Pathology, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA

    William J. Kupsky

  4. Department of Neurosurgery Case, Western University School of medicine, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Andrew E. Sloan

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  1. Thomas L. Beaumont
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  2. William J. Kupsky
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  3. Geoffrey R. Barger
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  4. Andrew E. Sloan
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Correspondence to Andrew E. Sloan.

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Beaumont, T.L., Kupsky, W.J., Barger, G.R. et al. Gliosarcoma with multiple extracranial metastases: case report and review of the literature. J Neurooncol 83, 39–46 (2007). https://doi.org/10.1007/s11060-006-9295-x

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  • DOI: https://doi.org/10.1007/s11060-006-9295-x

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