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Chondroblastic Osteosarcoma Arising in a Recurrent Glioblastoma
Author(s) -
Hagen Matthew Carlisle,
Horner Terry G.,
Hattab Eyas M.
Publication year - 2008
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.22.1_supplement.706.14
Subject(s) - gliosarcoma , medicine , osteosarcoma , glioblastoma , radiation therapy , malignant transformation , chondrosarcoma , fibrosarcoma , sarcoma , chemotherapy , radiology , pathology , surgery , cancer research
Gliosarcoma is a rare, highly malignant, primary glial neoplasm accounting for less than 2% of glioblastomas. Gliosarcomas are thought to arise de novo, occasionally undergoing metaplastic transformation. The metaplastic elements, usually in the form of cartilage and bone, are typically well‐differentiated with only exceptional malignant examples. We report one such case in a 45‐year‐old man who initially presented with dysphasia. A left temporal mass was discovered by head CT and a subtotal resection was performed. Pathologic examination revealed a glioblastoma. The patient received shaped external beam radiation, was placed on chemotherapy, and followed with serial MRIs. At 3 months abnormal enhancement adjacent to the resection cavity led to stereotactic radiotherapy. At 15 months there was increased enhancement in the wall of the resection cavity, though no mass lesions were seen. At 18 months a heterogeneously enhancing mass was seen in the left temporal region measuring 4.2 cm, which grew to 6.6 cm in just over 2 weeks. The patient underwent a second resection. The tumor was composed of three components: a classic glioblastoma, a sarcomatous component resembling a fibrosarcoma or malignant fibrous histiocytoma, and a malignant cartilaginous and osteosarcomatous component reminiscent of a chondroblastic osteosarcoma. This case illustrates an exceedingly rare occurrence of malignant cartilaginous and osseous elements in glioblastoma/gliosarcoma. It is unique in that the sarcomatous elements were only represented in the recurrence, which occurred over a relatively short period of time (18 months).