Journal of Neuro-Oncology

, Volume 103, Issue 3, pp 765–770 | Cite as

Gliosarcoma with bone infiltration and extracranial growth: case report and review of literature

  • Patrick Schuss
  • Christian T. Ulrich
  • Patrick N. Harter
  • Dominique S. Tews
  • Volker Seifert
  • Kea Franz
Case Report


Gliosarcoma is a relatively rare and highly malignant brain tumor consisting of both a glioblastoma and a mesenchymal component. Because of the natural barrier of the dura mater, that prevents intra or extradural neoplasm dissemination, cases of penetration of the dura and cranium by gliosarcomas without previous surgery or radiation are very rarely reported. We report an unusual case of gliosarcoma that involved the temporal skull base and the dura without antecedent radiation or surgery, although the lesion traversed the dura without radiologic or gross interruption of the dura. Remarkable in our case is the initial integrity of cerebral parenchyma. Follow-up revealed a tumorous infiltration of the temporal lobe almost one year after initial diagnosis. Thus the origin of the gliosarcoma in our case seemed to be extradural in the temporal skull base. Furthermore, this report demonstrates that extensive multi-modality treatment might be effective in patients with gliosarcomas and poor prognostic factors, for example unmethylated MGMT status.


Gliosarcoma Extradural growth Bone infiltration Infratemporal fossa penetration 



Glial fibrillary acidic protein


Epidermal growth factor receptor


European Organisation for Research and Treatment of Cancer


  1. 1.
    Ohgaki H, Biernat W, Reis R, Hegi M, Kleihues P (2000) Gliosarcoma. In: Kleihues PCW, Cavenee WK (eds) Pathology and genetics of tumours of the central nervous system, vol 2000. World health organization classification of tumours, 2nd edn. IARC Press, Lyon, France, pp 42–44Google Scholar
  2. 2.
    Lutterbach J, Guttenberger R, Pagenstecher A (2001) Gliosarcoma: a clinical study. Radiother Oncol 61:57–64PubMedCrossRefGoogle Scholar
  3. 3.
    Galanis E, Buckner JC, Dinapoli RP, Scheithauer BW, Jenkins RB, Wang CH, O’Fallon JR, Farr G Jr (1998) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: North Central Cancer Treatment Group results. J Neurosurg 89:425–430PubMedCrossRefGoogle Scholar
  4. 4.
    Barresi V, Cerasoli S, Morigi F, Cremonini AM, Volpini M, Tuccari G (2006) Gliosarcoma with features of osteoblastic osteosarcoma. A review. Arch Pathol Lab Med 130:1208–1211PubMedGoogle Scholar
  5. 5.
    Lieberman KA, Fuller CE, Caruso RD, Schelper RL (2001) Postradiation gliosarcoma with osteosarcomatous components. Neuroradiology 43:555–558PubMedCrossRefGoogle Scholar
  6. 6.
    Shintaku M, Miyaji K, Adachi Y (1998) Gliosarcoma with angiosarcomatous features: a case report. Brain Tumor Pathol 15:101–105PubMedCrossRefGoogle Scholar
  7. 7.
    Banerjee AK, Sharma SB, Kak VK, Ghatak NR (1989) Gliosarcoma with cartilage formation. Cancer 63:518–523PubMedCrossRefGoogle Scholar
  8. 8.
    Barnard RO, Bradford R, Scott T, Thomas DGT (1986) Gliomyosarcoma: report of a case of rhabdomyosarcoma arising in a malignant glioma. Acta Neuropathol (Berl) 69:23–27CrossRefGoogle Scholar
  9. 9.
    Vlodavsky EKM, Konstantinesku M, Soustiel JF (2006) Gliosarcoma with liposarcomatous differentiation. The new member of the lipid-containing brain tumors family. Arch Pathol Lab Med 130:381–384PubMedGoogle Scholar
  10. 10.
    Borota OC, Scheie D, Bjerkhagen B, Jacobsen EA, Skullerud K (2006) Gliosarcoma with liposarcomatous component, bone infiltration and extracranial growth. Clin Neuropathol 25(4):200–203Google Scholar
  11. 11.
    Sade B, Prayson RA, Lee JH (2006) Gliosarcoma with infratemporal fossa extension. J Neurosurg 105:904–907PubMedCrossRefGoogle Scholar
  12. 12.
    Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996. doi: 352/10/987[pii]10.1056/NEJMoa043330 PubMedCrossRefGoogle Scholar
  13. 13.
    Aoyama I, Makita Y, Nabeshima S, Motomochi M, Masuda A (1980) Extradural nasal and orbital extension of glioblastoma multiforme without previous surgical intervention. Surg Neurol 14:343–347PubMedGoogle Scholar
  14. 14.
    Rubinstein LJ (1967) Development of extracranial metastases from a malignant astrocytoma in the absence of previous craniotomy: case report. J Neurosurg 26:542–547PubMedCrossRefGoogle Scholar
  15. 15.
    Schuster H, Jellinger K, Gund A, Regele H (1976) Extracranial metastases of anaplastic cerebral gliomas. Acta Neurochir (Wien) 35:247–259CrossRefGoogle Scholar
  16. 16.
    Pompili A, Calvosa F, Caroli F, Mastrostefano R, Occhipinti E, Raus L, Sciarretta F (1993) The transdural extension of gliomas. J Neurooncol 15:67–74PubMedCrossRefGoogle Scholar
  17. 17.
    Orita T, Nishizaki T, Furutani Y, Aoki H (1989) Extradural nasal and orbital extension of malignant glioma: case report. Surg Neurol 31:395–399PubMedCrossRefGoogle Scholar
  18. 18.
    Murphy MN, Korkis JA, Robson FC, Sima AA (1985) Gliosarcoma with cranial penetration and extension to the maxillary sinus. J Otolaryngol 14:313–316PubMedGoogle Scholar
  19. 19.
    Morantz RA, Feigin I, Ransohoff J (1976) Clinical and pathological study of 24 cases of gliosarcoma. J Neurosurg 45:398–408PubMedCrossRefGoogle Scholar
  20. 20.
    Kaschten BFP, Flandroy P, Reznil M, Hainaut H, Stevenaert A (1995) Radiation-induced gliosarcoma. J Neurosurg 83:154–162PubMedCrossRefGoogle Scholar
  21. 21.
    Malde R, Jalali R, Muzumdar D, Shet T, Kurkure P (2004) Gliosarcoma occurring 8 years after treatment for a medulloblastoma. Childs Nerv Syst 20:243–246PubMedCrossRefGoogle Scholar
  22. 22.
    Biernat W, Aguzzi A, Sure U, Grant JW, Kleihues P, Hegi ME (1995) Identical mutations of the p53 tumor suppressor gene in the gliomatous and the sarcomatous components of gliosarcoma suggest a common origin from glial cells. J Neuropathol Exp Neurol 54:651–656PubMedCrossRefGoogle Scholar
  23. 23.
    Reis RM, Konu-Lebleblicioglu D, Lopes JM, Kleiheus P, Ohgaki H (2000) Genetic profile of gliosarcomas. Am J Pathol 156:425–432PubMedCrossRefGoogle Scholar
  24. 24.
    Meis JM, Martz KL, Nelson JS (1991) Mixed glioblastoma multiforme and sarcoma. A clinicopathologic study of 26 radiation therapy oncology group cases. Cancer 67:2342–2349PubMedCrossRefGoogle Scholar
  25. 25.
    Kawano N, Yada K, Ogawa Y, Sasaki K (1977) Spontaneous transdural extension of malignant astrocytoma. J Neurosurg 47:766–770PubMedCrossRefGoogle Scholar
  26. 26.
    Shenoy SN, Raja A (2005) Spontaneous transdural spread of glioblastoma with atypical presentation. Br J Neurosurg 19(1):61–65Google Scholar
  27. 27.
    Sanerkin N (1962) Transdural spread of glioblastoma multiforme. J Pathol Bacteriol 84:228–233PubMedCrossRefGoogle Scholar
  28. 28.
    Kang SH, Park KJ, Kim CY, Yu MO, Park CK, Park SH, Chung YG (2010) O(6)-methylguanine DNA methyltransferase status determined by promoter methylation and immunohistochemistry in gliosarcoma and their clinical implications. J Neurooncol. doi: 10.1007/s11060-010-0267-9
  29. 29.
    Prados MD, Chang SM, Butowski N, DeBoer R, Parvataneni R, Carliner H, Kabuubi P, Ayers-Ringler J, Rabbitt J, Page M, Fedoroff A, Sneed PK, Berger MS, McDermott MW, Parsa AT, Vandenberg S, James CD, Lamborn KR, Stokoe D, Haas-Kogan DA (2009) Phase ii study of erlotinib plus temozolomide during and after radiation therapy in patients with newly diagnosed glioblastoma multiforme or gliosarcoma. J Clin Oncol 27(4):579–584. doi: JCO.2008.18.9639[pii]10.1200/JCO.2008.18.9639 PubMedCrossRefGoogle Scholar
  30. 30.
    Wen PY, Fine HA, Black PM, Shrieve DC, Alexander E III, Loeffler JS (1995) High-grade astrocytomas. Neurol Clin 13(4):875–900PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Patrick Schuss
    • 1
  • Christian T. Ulrich
    • 1
  • Patrick N. Harter
    • 2
  • Dominique S. Tews
    • 2
  • Volker Seifert
    • 1
  • Kea Franz
    • 1
  1. 1.Department of NeurosurgeryJohann Wolfgang Goethe-University Frankfurt am MainFrankfurt am MainGermany
  2. 2.Institute of Neurology (Edinger Institute)Johann Wolfgang Goethe-University Frankfurt am MainFrankfurt am MainGermany

Personalised recommendations