NADİR BİR SANTRAL SİNİR SİSTEMİ TÜMÖRÜ: GLİOSARKOMA, OLGU SUNUMU

Gliosarkoma primer merkezi sinir sistemi tümörlerinin nadir bir formudur. 2007 Dünya Sağlık Örgütü (WHO) kriterlerine göre glioblastomanın bir varyantı olarak kabul edilir. Sıklıkla serebral hemisferleri tutar. Gliosarkomlar malign glial ve mezenkimal komponent içeren bifazik tümörlerdir. Gliosarkomun glioblastomdan ayırımında immunohistokimyanın önemi büyüktür. Gelişim mekanizmaları net değildir. Büyük kısmının de novo olarak geliştiği daha az bir kısmının glioblastome multiformenin daha önce bu sebeple rezeksiyon ve radyoterapi yapılmış alanlardan geliştiği de düşünülmektedir. Yapılan moleküler genetik çalışmalar gliosarkomun her iki komponentinin de monoklonal prekürsör hücrelerden köken aldığını öne sürmektedir. Çalışmamızda acil servise baş ağrısı ile başvuran 53 yaşında erkek hastadaki gliosarkom olgusu sunulmaktadır. Gliosarkomların klinik, histopatolojik ve immünhistokimyasal özelliklerini tanımlamak ve patogenetik mekanizmalırını tartışmak hedeflenmiştir.

A RARE CENTRAL NERVOUS SYSTEM TUMOR: GLIOSARCOMA, CASE REPORT

Gliosarcoma is a rare tumor of the central nervous system composed of glial and mesenchymal components. It is considered to be a glioblastoma variant according to the 2007 World Health Oranization (WHO) classification and often holding the cerebral hemispheres. Gliosarcomas are biphasic tumors that containing malignant glial and mesenchymal components. Immunohistochemistry is important to distinguish gliosarcoma and glioblastoma. Developmental mechanisms of gliosarcomas are not clear. It is considered that large part of gliosarcomas develop as de novo, and lesser part of them develop after resection and radiotherapy for glioblastome multiforme. Molecular genetic studies suggest that the two components of gliosarcoma origin of monoclonal precursor cells. In this study a case of gliosarcoma in 53 years old man who applied to emergency room with headache, is reported. We aimed to describe clinical, histopatological and immunohistochemical features of gliosarcoma and to discuss its pathogenetic mechanisims.

___

  • 1. Gök A, Bakır K, Ük C, Erkutlu İ, Gök M. Gliosarcoma: case report and review of the literature. Türk Nöroşurirji Dergisi. 2003;13:282-6
  • 2. Kobayashi T, Sakai K, Tada T, et al. Gliosarcoma arising from a fibrillary astrocytoma. J Clin Neurosci. 2011;18:1251-4
  • 3. Louis DN, Ohgaki H, Wiestler OD, Cavenee WK. Astrocytic tumours, “Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. WHO Classification of tumours of the central nervous system.” p. 13-5, IARC, Lyon (2007).
  • 4. Moon SK, Kim EJ, Choi WS, et al. Gliosarcoma of cerebellar hemisphere: a case report and review of the literature. Korean J Radiol. 2010;11:566-70
  • 5. Khanna M, Siraj F, Chopra P, et al. Gliosarcoma with prominent smooth muscle component (gliomyosarcoma): A report of 10 cases. Indian J Pathol Microbiol. 2011;54:51-4
  • 6. Barut F, Kandemir NO, Ozdamar SO, et al. Gliosarcoma with chondroblastic osteosarcomatous differentation: report of two case with clinicopathologic and immunhistochemical features. Turkish Neurosurgery. 2009;19:417-22
  • 7. Han SJ, Yang I, Tihan T, et al. Primary gliosarcoma: key clical and pathologic distinctions from glioblastoma with implications as a unique oncologic entity. J Neurooncol. 2010;96:313-20
  • 8. Cochran EJ: Central Nervous System, “ Gattuso P, Reddy VB, David O, Spitz DJ, Haber MH (eds): Differential Diagnosis in Surgical Pathology. 2nd edition.” p.987-1049, Saunders Elsevier, Philadelphia (2010).
  • 9. Maeda D, Miyazawa T, Toyooka T, Shima K. Temporal gliosarcoma with extraneural metastasis. Neurol Med Chir. 2010;50:343-5
  • 10. Biernat W, Aguzzi A, Sure U, et al. Identical mutations of the p53 tumor supressor gene in the gliomatous and the sarcomatous components suggests a common orıgın from glial cells. J Neuropathol Exp Neurol. 1995;54:651-6
  • 11. Machuca TN, Prevedello DM, Pope LZ, et al. Gliosarcoma: Report of four cases with immunhistochemical findings. Arq Neuropsiquatr. 2004;62(3A):608-12
  • 12. Reis RM, Könü-Lebleblicioglu D, Lopes JM, et al. Genetic profile of gliosarcomas. Am J Pathol. 2000;156:425-32