Primary Gliosarcoma of the Cerebellum in a Young Pregnant Woman: Management Challenges and Immunohistochemical Features

Abstract

Background. Gliosarcoma (GS) represents a rare, high-grade (WHO Grade IV), central nervous system neoplasm, characterized by a very poor prognosis. Similar to other high-grade gliomas, GS affects mainly adults in the 5th-7th decade of life and presents a higher incidence in males. The most reported locations of GS are the temporal lobe and the frontal lobe, while only eight cases of GS originating from the posterior cranial fossa are reported in the literature. Case Description. We report the first case occurring during pregnancy in a 33-year-old patient. Diagnosis was obtained on the 15th week of gestation when patient presented with signs and symptoms of life-threatening raised intracranial pressure. Surgical excision was followed by early recurrence and eventually disease progression because the patient refused adjuvant treatment to save her fetus. Conclusions. GS should be considered in the differential diagnosis of posterior cranial fossa tumors with radiological features of meningioma or glioblastoma, even in young patients. To this regard, sarcomas, solitary fibrous tumors, and even metastases should be considered, especially in light of the tendency of GS to give rise to extracranial localizations. Whenever an aggressive management with radical excision and adjuvant treatment is not safely achievable, disease progression is likely to be unavoidable.

Management Challenges of Metastatic Spinal Cord Compression in Pregnancy

“…The most severe obstetrical risks of surgery in pregnancy are miscarriage, preterm delivery, and foetal distress due to foetal hypoxia [ 11 , 12 ]. Anaesthesiological management is critical, because maternal monitoring is essential to prevent hypoxia, hypoglycaemia, and hypotension [ 13 , 14 ]. No anaesthetic drug is risk-free in pregnant women due to their hypotensive effects; however, fentanyl, remifentanil, and sevoflurane are the most commonly adopted agents due to their pharmacological profile which is known not to induce any teratogenic effect [ 14 ].…”

“…Anaesthesiological management is critical, because maternal monitoring is essential to prevent hypoxia, hypoglycaemia, and hypotension [ 13 , 14 ]. No anaesthetic drug is risk-free in pregnant women due to their hypotensive effects; however, fentanyl, remifentanil, and sevoflurane are the most commonly adopted agents due to their pharmacological profile which is known not to induce any teratogenic effect [ 14 ]. Patient positioning is also very important because safe spinal surgery can only be conducted by reducing blood loss and minimising pressure-related issues.…”

“…Patient positioning is also very important because safe spinal surgery can only be conducted by reducing blood loss and minimising pressure-related issues. This is particularly relevant in pregnant patients with distended uterus and diversion of a significant amount of their blood volume through the placenta [ 14 ]. As such, paddings should be carefully positioned by the surgical staff to ensure that the abdomen is free from compression, while the rest of the patients' body is well supported.…”

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

“…5,8,10 Gliosarcoma is rarest in the infratentorial region of the brain, the ventricles, the pineal gland, and the optic nerve. [12][13][14][15] Most cases present with a single mass, and multiple masses are rarely reported. 16,17 Gliosarcoma often grows across the brain lobes, and it generally has a large volume and an obvious space-occupying effect and can easily invade the adjacent meninges.…”