Abstract

Objective: Gliosarcomas (GS) comprise ~ 2 – 8% of glioblastomas and are associated with a similar poor prognosis. GS have rarely been found with a primitive neuroectodermal component (PNET). We present a case of gliosarcoma with PNET features (GS-PNET) that mimicked a neuroendocrine carcinoma on initial biopsy.
Materials and methods: A 68-year-old male presented with 2 weeks of increasing headaches and difficulties with reading, writing, and word-finding. He was found to have a left-sided parieto-occipital heterogeneously enhancing mass.
Results: Pathologic analysis after surgical resection initially diagnosed a poorly differentiated carcinoma with neuroendocrine features, and adjuvant therapy was guided by this diagnosis as well as systemic imaging, which was suggestive of gastrointestinal primary malignancy with central nervous system (CNS) metastasis. Subsequent progression and re-resection established a diagnosis of GS with PNET component. Genomic profiling showed shared PTEN, TERT promotor, and TP53 mutations in the original and recurrent tumors.
Conclusion: There have only been 5 previously reported cases of GS-PNET, to our knowledge, with this case representing the first with comprehensive molecular profiling. The case also highlights the importance of further work-up of presumed metastatic carcinoma with indeterminate immunostaining and/or suspected non-epithelioid component.

Author Details

Authors

• Ben G. McGahan¹
• Nathaniel Toop¹
• Spencer Ward⁵
• Dan Jones^{2, 3}
• Peter J. Kobalka²
• Joshua D. Palmer^{1, 4}
• James B. Elder¹

Departments

• ¹ Department of Neurosurgery,
• ² Department of Pathology, The Ohio State Wexner Medical Center, Columbus, OH,
• ³ Molecular Pathology, The Ohio State University Comprehensive Cancer Center, Columbus, OH,
• ⁴ Department of Radiation Oncology, The Ohio State Wexner Medical Center, Columbus OH, and
• ⁵ The Ohio State College of Medicine, Columbus, OH, USA

Address

Ben G. McGahan, MD
Department of Neurosurgery
The Ohio State Wexner Medical Center
410 W 10th Ave
Columbus, OH 43210, USA
Email: [email protected]

Citation