Detailed magnetic resonance imaging features of a case series of primary gliosarcoma

Abstract

Objective

We aimed to characterise the magnetic resonance imaging (MRI) features of a case series of primary gliosarcoma, with the inclusion of diffusion-weighted imaging and perfusion imaging with dynamic susceptibility contrast MRI.

Materials and methods

We conducted a retrospective study of cases of primary gliosarcoma from the Pathology Department database from January 2006 to December 2014. Clinical and demographic data were obtained. Two neuroradiologists, blinded to diagnosis, assessed tumour location, signal intensity in T1 and T2-weighted images, pattern of enhancement, diffusion-weighted imaging and dynamic susceptibility contrast MRI studies on preoperative MRI.

Results

Seventeen patients with primary gliosarcomas had preoperative MRI study: seven men and 10 women, with a mean age of 59 years (range 27–74). All lesions were well demarcated, supratentorial and solitary (frontal n = 5, temporal n = 4, parietal n = 3); 13 tumours abutted the dural surface (8/13 with dural enhancement); T1 and T2-weighted imaging patterns were heterogeneous and the majority of lesions (12/17) showed a rim-like enhancement pattern with focal nodularities/irregular thickness. Restricted diffusion (mean apparent diffusion coefficient values 0.64 × 10^–3 mm²/s) in the more solid/thick components was present in eight out of 11 patients with diffusion-weighted imaging study. Dynamic susceptibility contrast MRI study (n = 8) consistently showed hyperperfusion in non-necrotic/cystic components on relative cerebral volume maps.

Conclusions

The main distinguishing features of primary gliosarcoma are supratentorial and peripheral location, well-defined boundaries and a rim-like pattern of enhancement with an irregular thick wall. Diffusion-weighted imaging and relative cerebral volume map analysis paralleled primary gliosarcoma with high-grade gliomas, thus proving helpful in differential diagnosis.

Keywords

Gliosarcoma magnetic resonance imaging diffusion magnetic resonance imaging perfusion imaging brain neoplasms diagnosis differential

Get full access to this article

View all access options for this article.

References

Lutterbach

Guttenberger

Pagenstecher

. Gliosarcoma: a clinical study. Radiother Oncol 2001; 61: 57–64.

Louis

Perry

Reifenberger

et al.

The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 2016; 131: 803–820.

Miller

Perry

. Glioblastoma. Arch Pathol Lab Med 2007; 131: 397–406.

Linhares

Martinho

Carvalho

et al.

Analysis of a synchronous gliosarcoma and meningioma with long survival: a case report and review of the literature. Surg Neurol Int 2013; 4: 151.

Cervoni

Celli

. Cerebral gliosarcoma: prognostic factors. Neurosurg Rev 1996; 19: 93–96.

Han

Yang

Ahn

et al.

Clinical characteristics and outcomes for a modern series of primary gliosarcoma patients. Cancer 2010; 116: 1358–1366.

Maiuri

Stella

Benvenuti

et al.

Cerebral gliosarcomas: correlation of computed tomographic findings, surgical aspect, pathological features, and prognosis. Neurosurgery 1990; 26: 261–267.

Morantz

Feigin

Ransohoff

III . Clinical and pathological study of 24 cases of gliosarcoma. J Neurosurg 1976; 45: 398–408.

Salvati

Caroli

Raco

et al.

Gliosarcomas: analysis of 11 cases do two subtypes exist?

J Neurooncol 2005; 74: 59–63.

10.

Witwer

Salamat

Resnick

. Gliosarcoma metastatic to the cervical spinal cord: case report and review of the literature. Surg Neurol 2000; 54: 373–378. discussion 8–9.

11.

Actor

Cobbers

Buschges

et al.

Comprehensive analysis of genomic alterations in gliosarcoma and its two tissue components. Genes Chromosomes Cancer 2002; 34: 416–427.

12.

Reis

Konu-Lebleblicioglu

Lopes

et al.

Genetic profile of gliosarcomas. Am J Pathol 2000; 156: 425–432.

13.

Osborn

Jhaveri

Salzman

. Diagnostic imaging. Brain, 3rd edn. Philadelphia, PA: Elsevier, 2016. , p. xxi, i–xiv pp.

14.

Han

Zhang

Qiu

et al.

Magnetic resonance imaging of primary cerebral gliosarcoma: a report of 15 cases. Acta Radiol 2008; 49: 1058–1067.

15.

Romero-Rojas

Diaz-Perez

Ariza-Serrano

et al.

Primary gliosarcoma of the brain: radiologic and histopathologic features. Neuroradiol J 2013; 26: 639–648.

16.

Zhang

Chen

Geng

et al.

Computed tomography and magnetic resonance features of gliosarcoma: a study of 54 cases. J Comput Assist Tomogr 2011; 35: 667–673.

17.

Damodaran

van Heerden

Nowak

et al.

Clinical management and survival outcomes of gliosarcomas in the era of multimodality therapy. J Clin Neurosci 2014; 21: 478–481.

18.

Stupp

Mason

van den Bent

et al.

Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005; 352: 987–996.

19.

Galanis

Buckner

Dinapoli

et al.

Clinical outcome of gliosarcoma compared with glioblastoma multiforme: North Central Cancer Treatment Group results. J Neurosurg 1998; 89: 425–430.

20.

Meis

Martz

Nelson

. Mixed glioblastoma multiforme and sarcoma: a clinicopathologic study of 26 Radiation Therapy Oncology Group cases. Cancer 1991, pp. 2342–2349.

21.

Parekh

O’Donovan

Sharma

et al.

Primary cerebral gliosarcoma: report of 17 cases. Br J Neurosurg 1995; 9: 171–178.

22.

Perry

Ang

Bilbao

et al.

Clinicopathologic features of primary and postirradiation cerebral gliosarcoma. Cancer 1995; 75: 2910–2918.

23.

Sarkar

Sharma

Sudha

et al.

A clinico-pathological study of 29 cases of gliosarcoma with special reference to two unique variants. Ind J Med Res 1997; 106: 229–235.

24.

Singh

Das

Sharma

et al.

Cerebral gliosarcoma: analysis of 16 patients and review of literature. Asian J Neurosurg 2015; 10: 195–202.

25.

Dwyer

Naul

Hise

. Gliosarcoma: MR features. J Comput Assist Tomogr 1996; 20: 719–723.

26.

Louis

Ohgaki

Wiestler

et al.

The 2007 WHO Classification of tumours of the central nervous system. Acta Neuropathol 2007; 114: 97–109.

27.

Fukuda

Yasumichi

Suzuki

. Immunohistochemistry of gliosarcoma with liposarcomatous differentiation. Pathol Int 2008; 58: 396–401.

28.

Beaumont

Kupsky

Barger

et al.

Gliosarcoma with multiple extracranial metastases: case report and review of the literature. J Neurooncol 2007; 83: 39–46.

29.

Cerame

Guthikonda

Kohli

. Extraneural metastases in gliosarcoma: a case report and review of the literature. Neurosurgery 1985; 17: 413–418.

30.

Ehrenreich

Devlin

. A complex of glioblastoma and spindle-cell sarcoma with pulmonary metastases. Arch Pathol 1958, pp. 56–549.

31.

Feigin

Gross

. Sarcoma arinsing in glioblastoma of the brain. Am J Pathol 1954, pp. 633–653.

32.

Garret

. Glioblastoma and fibrossarcoma of the brain with extracranial metastases. Cancer 1958, pp. 888–894.

33.

Matsuyama

Mori

Hori

et al.

Gliosarcoma with multiple extracranial metastasess. Case Report. Neurol Med Chir (Tokyo) 1989, pp. 938–943.

34.

Ojeda

Sterrett

. Cerebral gliosarcoma, pulmonary adenoid-cystic carcinoma, and pulmonary metastatic gliosarcoma: report of an untreated case. Pathology 1984; 16: 217–221.

35.

Smith

Hardman

Earle

. Contiguous glioblastoma multiforme and fibrosarcoma with extracranial metastasis. Cancer 1969; 24: 270–276.

36.

Weaver

Vandenberg

Park

et al.

Selective peripancreatic sarcoma metastases from primary gliosarcoma. Case report. J Neurosurg 1984; 61: 599–601.

37.

Wharton

Whittle

Collie

et al.

Gliosarcoma with areas of primitive neuroepithelial differentiation and extracranial metastasis. Clin Neuropathol 2001; 20: 212–218.

38.

Yokoyama

Ono

Mori

et al.

Extracranial metastasis of glioblastoma with sarcomatous component. Surg Neurol 1985; 24: 641–645.

39.

Dawar

Fabiano

Qiu

et al.

Secondary gliosarcoma with extra-cranial metastases: a report and review of the literature. Clin Neurol Neurosurg 2013; 115: 375–380.

40.

Han

Yang

Tihan

et al.

Primary gliosarcoma: key clinical and pathologic distinctions from glioblastoma with implications as a unique oncologic entity. J Neurooncol 2010; 96: 313–320.

41.

Biswas

Kumar

et al.

Primary gliosarcoma – clinical experience from a regional cancer centre in north India. Br J Neurosurg 2011; 25: 723–729.

42.

Chiang

Kuo

et al.

Distinction between high-grade gliomas and solitary metastases using peritumoral 3-T magnetic resonance spectroscopy, diffusion, and perfusion imagings. Neuroradiology 2004; 46: 619–627.

43.

Usinskiene

Ulyte

Bjornerud

et al.

Optimal differentiation of high- and low-grade glioma and metastasis: a meta-analysis of perfusion, diffusion, and spectroscopy metrics. Neuroradiology 2016; 58: 339–350.

44.

Cha

Lupo

Chen

et al.

Differentiation of glioblastoma multiforme and single brain metastasis by peak height and percentage of signal intensity recovery derived from dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging. AJNR Am J Neuroradiol 2007; 28: 1078–1084.