Primary intraventricular gliosarcoma on MRI: A challenging diagnosis

Abstract

Gliosarcoma (GS) is an uncommon central nervous system tumor with several characteristics of a malignant neoplasm and poor prognosis. The majority of GS reports describe a predilection for the cerebral hemispheres, and cases of intraventricular GS are extremely rare, with only a few reported. In addition, intraventricular GS has not been associated with any unique radiographic or clinical features, which can result in misdiagnosis as other intraventricular tumor types. In this report, we present the case of a 32-year-old woman with GS in the trigone of the lateral ventricle and provide a retrospective review of similar, previously reported cases.

A Rare Tumor in a Rare Location: Radiology and Pathology Findings With a Literature Review on Intraventricular Gliosarcoma

“…Of note, all reported cases of IVGS thus far have been located in the lateral or third ventricle, abutting or involving the septum pellucidum [5]. Our case has congruent imaging findings, with CT demonstrating a heterogeneous soft tissue nodule in the left ventricle extending into the interventricular foramen and subsequent MRI imaging demonstrating a T1 hypointense, T2 hyperintense, heterogeneously enhancing intraventricular mass located in the left frontal horn at the level of the foramen of Monro [6]. A similar presentation of an IVGS rising from the left frontal horn of the left ventricle has been reported previously [Hou et al,15].…”

“…To the best of our knowledge, this is the oldest patient with an initial presentation of an IVGS. The differential diagnosis for an intraventricular tumor primarily includes low-grade glial or glioneuronal tumors, including neurocytomas, subependymomas, and ependymomas, as well as choroid plexus tumors, although astrocytic tumors may be seen as well [6,15]. Additionally, CT and MRI imaging findings can aid in differentiating gliosarcoma from other high-grade gliomas.…”

“…GS usually presents as a supratentorial intraparenchymal lesion abutting the meninges, which is not unlike the presentation of a meningioma and has a predilection for the temporal, frontal, parietal, and occipital lobes in order of preference [4][5][6]. Exceptionally rare occurrences of GS in the intraventricular location have been reported in the literature [4][5][6][7][8][9][10][11][12][13][14][15][16]. However, given the lack of discrete imaging characteristics, intraventricular gliosarcoma (IVGS) can often be misdiagnosed as a lower-grade astrocytoma on initial evaluation [6].…”

“…Exceptionally rare occurrences of GS in the intraventricular location have been reported in the literature [4][5][6][7][8][9][10][11][12][13][14][15][16]. However, given the lack of discrete imaging characteristics, intraventricular gliosarcoma (IVGS) can often be misdiagnosed as a lower-grade astrocytoma on initial evaluation [6]. Given its high connective tissue content, gliosarcoma also has the gross appearance of a wellcircumscribed mass, resembling a meningioma.…”

“…GS usually presents as a supratentorial intraparenchymal lesion abutting the meninges, which is not unlike the presentation of a meningioma and has a predilection for the temporal, frontal, parietal, and occipital lobes in order of preference [ 4 - 6 ]. Exceptionally rare occurrences of GS in the intraventricular location have been reported in the literature [ 4 - 16 ].…”