Uncommon instance of gliosarcoma: Detailed radiological, histopathological, and clinical understandings for diagnosis and treatment strategies
A 30-year-old female patient presented with a 10-day history of persistent right-sided headache and recurrent vomiting. The magnetic resonance imaging (MRI) revealed a heterogeneously enhancing mass lesion involving the right parietal region and the splenium of the corpus callosum.
The imaging features suggested a high suspicion of glioblastoma multiforme, a highly aggressive primary brain tumor. The lesion appeared heterogeneously hypointense on T1-weighted imaging (T1WI) and heterogeneously hyperintense on T2/FLAIR sequences. Diffusion-weighted imaging (DWI) revealed areas of restricted diffusion, indicative of high cellular density and tumor aggressiveness. Susceptibility-weighted imaging (SWI) demonstrated areas of blooming, suggestive of intralesional hemorrhage.
The patient underwent surgical resection, and histopathological examination confirmed gliosarcoma. This rare and aggressive variant of glioblastoma is classified as a World Health Organization (WHO) grade IV glioma. Gliosarcoma is characterized by a biphasic histological pattern consisting of both glial and mesenchymal components.
The case was further diagnosed as gliosarcoma after histopathological examination. The lesion was noted to cross the midline and caused significant effacement of the occipital horns of the bilateral lateral ventricles and the third ventricle, leading to features consistent with obstructive hydrocephalus.
Current advanced therapeutic strategies for treating gliosarcoma primarily consist of a multimodal approach involving surgery, radiotherapy, and chemotherapy. Gross total resection (complete tumor removal) is associated with improved prognosis and is a key initial therapeutic step whenever feasible. Adjuvant radiotherapy is recommended for all gliosarcoma patients after surgery, typically delivering total doses in the range of 50–65 Gy, often given in conventional fractionation. High-dose radiotherapy correlates with reduced mortality.
Temozolomide-based chemotherapy is widely used following glioblastoma treatment guidelines. Meta-analyses and clinical reports indicate that temozolomide combined with radiotherapy reduces all-cause mortality in gliosarcoma patients. However, there remains debate over its definitive value due to the lack of large-scale randomized clinical trials exclusively focused on gliosarcoma.
Ongoing investigations include trials combining alkylating agents such as temozolomide and lomustine with radiotherapy to enhance overall survival, though specific outcomes for gliosarcoma are still emerging. Some case reports mention the use of targeted agents like bevacizumab (an anti-VEGF monoclonal antibody) in second-line treatment for specific molecular subtypes of gliosarcoma such as EGFR-amplified tumors. Research is also focusing on molecular targets such as the L-type amino acid transporter 1 (LAT1) for enhancing the delivery of novel therapies like boron neutron capture therapy, emphasizing developing tumor-specific drug delivery systems.
Prognosis remains poor for gliosarcoma with median survival typically between 8 to 17 months despite these therapies. Continued research is crucial to improve patient outcomes given gliosarcoma's aggressive nature and distinct metastatic potential compared to classical glioblastoma.
In summary, advanced current treatments for gliosarcoma include maximal surgical resection, high-dose radiotherapy, and temozolomide-based chemotherapy, with ongoing exploration of novel drug combinations and targeted molecular therapies aimed at improving survival beyond standard glioblastoma protocols.
