Metastatic Gliosarcoma: Cytopathologic Characteristics with Histopathologic Correlations

Lee, James; Rodríguez, Fausto J.; Ali, Syed Z.

doi:10.1159/000448509

Cited by 4 publications

(3 citation statements)

References 17 publications

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“…Endobronchial fine-needle aspiration (FNA) biopsy has been reported in the diagnosis of glioblastoma from a metastatic lung mass [ 25 ]. For suspected mediastinal involvement, endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) was reported diagnostic of gliosarcoma, a variant of glioblastoma, from a posterior mediastinal mass [ 26 ]. In one study of a metastatic glioblastoma to the lung with mediastinal lymphadenopathy, EBUS-TBNA was employed in the sampling of a subcarinal LN, which was nondiagnostic; however, although the patient underwent mediastinoscopy, it was unclear if the sampled LN was positive for glioblastoma (i.e., false-negative TBNA) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Metastatic Glioblastoma Diagnosed by Endobronchial Ultrasound-Transbronchial Needle Aspiration

Al-Sardi

Alfayez

Alwelaie

et al. 2022

Case Reports in Pulmonology

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Glioblastoma is a common primary brain tumor that has a high mortality rate. Reports of intrathoracic metastases are uncommon, with the most commonly reported site for metastases are the lung and pleura. However, involvement of the mediastinum is not well documented, and few reports of confirmed mediastinal metastases diagnosed by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) exist. Herein, we report a rare case of metastatic glioblastoma to the thorax. A lady in her 40s has been previously diagnosed with intracranial glioblastoma with multiple incidences of disease recurrence despite treatment with chemoradiotherapy, adjuvant chemotherapy, and repeated surgical resections. She presented with dyspnea and pleural effusion, for which radiological imaging revealed lung, pleural, and mediastinal lesions. Further diagnostic workup with EBUS and pleural fluid sampling confirmed metastatic disease to both sites. The pleural fluid showed highly atypical cells positive for GFAP, and EBUS-TBNA immunostains were GFAP, S100, and synaptophysin positive, giving an overall picture consistent with metastatic glioblastoma. The patient was referred for palliative care, and unfortunately, she passed away after several months.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of Metastatic Glioblastoma Diagnosed by Endobronchial Ultrasound-Transbronchial Needle Aspiration

Al-Sardi

Alfayez

Alwelaie

et al. 2022

Case Reports in Pulmonology

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“…The incidence of extracranial metastases of gliosarcoma is approximately 11%. 19 The most common sites of extracranial metastasis reported in the literature are the lung, the liver, and the lymph nodes. 20 The occurrence of metastases may be related to the dedifferentiation of sarcoma and the destruction of the normal anatomical barrier during surgical resection.…”

Section: Discussionmentioning

confidence: 99%

Computed Tomography, Magnetic Resonance Imaging, and Pathological Features of Gliosarcoma

Fan¹,

Yu²,

Du³

et al. 2022

NDT

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To investigate the clinical, imaging, and pathological features of gliosarcoma. Methods: The clinical data of 14 patients with gliosarcoma confirmed by surgery and pathology at our hospital between 2010 and 2021 were analyzed retrospectively, and the relevant literature was reviewed.Results: In all 14 cases, the gliosarcoma was located in the supratentorial brain parenchyma and involved a single lesion. There were more male patients (64.3%) than female patients (35.7%), and 57.1% of all the patients were 40-60 years of age. The prognosis of all 14 patients was poor, and the average survival time was approximately seven months. The computed tomography findings revealed mostly mixed density lesions, and some cases were complicated with bleeding. The magnetic resonance imaging revealed irregularly shaped mass lesions of different sizes, with uneven or circular enhancement. Cystic degeneration and necrosis could be seen in all the masses, some of which showed signs of bleeding and were surrounded by different degrees of edema and space-occupying effects. The pathological examination revealed that the tumors had bidirectional differentiation of the glial and sarcoma components, while the immunohistochemistry examination revealed glial fibrillary acidic protein-positive and reticular fiber-positive staining in the sarcoma. Conclusion:The clinical manifestations of gliosarcoma are nonspecific, but imaging reveals that the condition has certain characteristics, typically consisting of a huge supratentorial mass, with an irregular heterogeneous periphery or obvious mass-like augmentation after enhancement. The final diagnosis depends on the results of a pathological examination.

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“…Since the first description of systemic spread in GBM by Davis in 1928, 83 several risk factors have been proposed, including history of surgical intervention, [16][17][18] prolonged survival, 32 the presence of a sarcomatous component, 84 young age that may correspond to longer survival, 33 local tumor recurrence, and immunodeficiency in the context of organ transplantation from GBM donors. 38,85 We do note gliosarcomatous features in our cases, as well as a younger population.…”

Section: Discussionmentioning

confidence: 99%

TP53 Mutation and Extraneural Metastasis of Glioblastoma

Zhang¹,

Katsakhyan²,

LiVolsi³

et al. 2021

American Journal of Surgical Pathology

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Extraneural metastases of glioblastoma (GBM), although rare, are becoming an increasingly recognized occurrence. Currently, the biological mechanism underlying this rare occurrence is not understood. To explore the potential genomic drivers of extraneural metastasis in GBM, we present the molecular features of 4 extraneural metastatic GBMs, along with a comprehensive review and analysis of previously reported cases that had available molecular characterization. In addition to our 4 cases, 42 patients from 35 publications are reviewed. To compare the molecular profiles between GBM cases with extraneural metastasis and the general GBM population, genomic data from GBM samples in The Cancer Genome Atlas (TCGA) database were also analyzed. We found that 64.5% (20/31) of the cases with extraneural metastasis that were tested for TP53 changes had at least 1 TP53 pathogenic variant detected in either 1 or both primary and metastatic tumors. In contrast, TP53 mutation was significantly less frequent in the unselected GBM from TCGA (22.6%, 56/248) (P=0.000). In addition, O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation was more common in unselected TCGA GBM cases (48.6%, 170/350) than in cases with extraneural metastasis (31.8%, 7/22), although not statistically significant. Although isocitrate dehydrogenase (IDH) mutation is a rare occurrence in high-grade astrocytomas, IDH-mutant grade 4 astrocytomas are at least as likely to metastasize as IDH wild-type GBMs; 3 metastatic cases definitively harbored an IDH1 (p.R132H) mutation in our analysis. Our findings not only provide potential biomarkers for earlier screening of extraneural metastasis, but could also suggest clues to understanding biological mechanisms underlying GBM metastasis, and for the development of therapeutic modalities.

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Metastatic Gliosarcoma: Cytopathologic Characteristics with Histopathologic Correlations

Cited by 4 publications

References 17 publications

A Rare Case of Metastatic Glioblastoma Diagnosed by Endobronchial Ultrasound-Transbronchial Needle Aspiration

A Rare Case of Metastatic Glioblastoma Diagnosed by Endobronchial Ultrasound-Transbronchial Needle Aspiration

Computed Tomography, Magnetic Resonance Imaging, and Pathological Features of Gliosarcoma

TP53 Mutation and Extraneural Metastasis of Glioblastoma

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