Giant parieto-occipital lobe pediatric gliosarcoma: Report of a rare entity and review of literature

Abstract

Background: Gliosarcoma is a rare high-grade malignant tumor and a variant of glioblastoma characterized by biphasic glial and mesenchymal components. Gliosarcomas occur most commonly in the fifth or sixth decade of life and have a temporal lobe predilection. Occurrence in the pediatric population is extremely rare.

Case description: Here, we report the case of an 8-year-old child with histologically confirmed gliosarcoma at the parieto-occipital lobe. Only a subtotal resection of the tumor mass could be performed in view of massive bleeding from the tumor bed; and despite postoperative chemotherapy and radiotherapy, the tumor recurred in a short span of time. A repeat surgery was done but the patient could not survive.

Conclusion: To our knowledge, this case constitutes the second youngest case reported in the literature with the lesion in the parieto-occipital region and the third youngest in all pediatric cases of gliosarcoma. This case demonstrates that possibility of gliosarcoma should always be kept in mind in children presenting with features of intracranial high-grade glial tumor. This case also suggests that significant residual after surgery is one variable that may affect the prognosis despite radiotherapy and/or chemotherapy.

Keywords: Brain neoplasm; glioblastoma multiforme; gliosarcoma; pediatric brain tumor.

Figure 1

(a) CECT brain showing solid-cystic contrast enhancing mass left parieto-occipital lobe. (b) T1W MRI brain and (c) T2W MRI brain showing heterogenous signal intensity. (d) Sagittal and (e) coronal cuts of contrast MRI brain showing avid contrast enhancement. (f) CECT brain obtained after surgical resection of the mass showing significant residual tumor. (g) T2W MRI brain done after 6 months of surgery showing recurrent tumor. (h) Postoperative CT brain showing residual tumor and tumoral bed hematoma

Figure 2

(a) H and E ×10 Gliosarcoma spindle cells in short fascicles with fibrillar background. (b) H and E ×40 showing numerous atypical mitosis. (c) Reticulin stain GMS ×10 showing numerous reticulin black fibers surrounding tumor cells. (d) Immunohistochemistry ×10 GFAP stain showing few islands of tumor cells as brown staining, rest sarcomatous components are stainless