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Gliosarcoma: a clinical and radiological analysis of 48 cases

  • Oncology
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Abstract

Objectives

To retrospectively review the radiological and clinicopathological features of gliosarcoma (GSM) and differentiate it from glioblastoma multiforme (GBM).

Methods

The clinicopathological data and imaging findings (including VASARI analysis) of 48 surgically and pathologically confirmed GSM patients (group 1) were reviewed in detail, and were compared with that of other glioblastoma (GBM) cases in our hospital (group 2).

Results

There were 28 men and 20 women GSM patients with a median age of 52.5 years (range, 24-80 years) in this study. Haemorrhage (n = 21), a salt-and-pepper sign on T2-weighted images (n = 36), unevenly thickened wall (n = 36) even appearing as a paliform pattern (n = 32), an intra-tumoural large feeding artery (n = 32) and an eccentric cystic portion (ECP) (n = 19) were more commonly observed in the GSM group than in GBM patients. Based on our experience, GSM can be divided into four subtypes according to magnetic resonance imaging (MRI) features. When compared to GBM (group 2), there were more patients designated with type III lesions (having very unevenly thickened walls) and IV (solid) lesions among the GSM cases (group 1). On univariate prognostic analysis, adjuvant therapy (radiotherapy, chemotherapy, and radiochemotherapy) and existence of an eccentric cyst region were prognostic factors. However, Cox's regression model showed only adjuvant therapy as a prognostic factor for GSM.

Conclusions

When compared to GBM, certain imaging features are more likely to occur in GSM, which may help raise the possibility of this disease. All GSM patients are recommended to receive adjuvant therapy to achieve a better prognosis with radiotherapy, chemotherapy or radiochemotherapy all as options.

Key Points

• Diagnosis of gliosarcoma can be suggested preoperatively by imaging.

• Gliosarcoma can be divided into four subtypes based on MRI.

• Paliform pattern and ECP tend to present in gliosarcoma more than GBM.

• The cystic subtype of gliosarcoma may predict a more dismal prognosis.

• All gliosarcoma patients should receive adjuvant therapy to achieve better prognosis.

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Abbreviations

ECP:

Eccentric cystic portion

GBM:

Glioblastoma multiforme

GSM:

Gliosarcoma

HGG:

High-grade glioma

IHC:

Immunohistochemical

OS:

Overall survival

PSM:

Propensity score matching

VASARI:

Visually accessible rembrandt images

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Acknowledgements

Dr. Xiaoping Yi is right now a Postdoctoral Fellow in Postdoctoral Research Workstation of Pathology and Pathophysiology, Basic Medical Sciences, Xiangya Hospital, Central South University (No. 185705). We thank all the members of Department of Radiology and Professor Li’s Lab, Xiangya Hospital, for helpful discussion.

Funding

This study has received funding by the National Natural Science Foundation of China (No. 81472594, 81770781)

Author information

Author notes

  1. Xiaoping Yi and Hang Cao contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China

    Xiaoping Yi, Haiyun Tang & Weihua Liao

  2. Postdoctoral Research Workstation of Pathology and Pathophysiology, Basic Medical Sciences, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China

    Xiaoping Yi & Lunquan Sun

  3. Department of Neurosurgery, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China

    Hang Cao & Xuejun Li

  4. Department of Pathology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China

    Guanghui Gong & Zhongliang Hu

  5. Center for Molecular Medicine, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China

    Lunquan Sun

  6. Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, USA

    Bihong T. Chen

Authors
  1. Xiaoping Yi
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  2. Hang Cao
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  9. Xuejun Li
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Corresponding author

Correspondence to Xuejun Li.

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Guarantor

The scientific guarantor of this publication is Professor Xuejun Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• case-control study

• performed at one institution

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Yi, X., Cao, H., Tang, H. et al. Gliosarcoma: a clinical and radiological analysis of 48 cases. Eur Radiol 29, 429–438 (2019). https://doi.org/10.1007/s00330-018-5398-y

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  • DOI: https://doi.org/10.1007/s00330-018-5398-y

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