P17.06 * GLIOSARCOMA PRESENTING WITH PARIETAL SIGNS IN A 67 YEAR-OLD FILIPINO MALE: A CASE REPORT

Abstract

BACKGROUND:Gliosarcoma is a well-circumscribed tumor of the central nervous system with clearly identifiable biphasic glial andmetaplastic mesenchymal components (1). The incidence of gliosarcoma is between 1.8% and 2.8% of all malignant gliomas and thus represents an exceptionally rare neoplasm (3). The typical presentation of patients with gliosarcomawould be consistent with a rapidly growing intracranial tumor showing signs of increased intracranial pressure such as headache and vomiting, other signs include cognitive decline, hemiparesis andseizures. Literature about this disease entity has been limited to a few case reports and series due to its rarity. Pathogenesis remains unclear, and optimal treatment of gliosarcoma remains to be defined (3).Wereport a case of a 67 year-old male with a CNS tumor uniquely presenting only with parietal lobe signs, underwent craniotomy and tumor resection, with histopathology revealing a gliosarcoma. CASE: A 67 year-old male, a mechanical engineer, initially presented at a different institution due to a month's history of difficulty in reading, writing, and calculating. A cranialMRI was done with findings of a subacute infarct over the left occipital and part of the lateral temporal lobe. Patient was initially treated as a case of stroke, but noted progression of earlier described symptoms. Patient now sought consult at our institution where an MR spectroscopy and perfusion was done showing a lobulated lesion in the left occipito-temporal lobe with moderate perilesional edema extending into the left temporal and parietal lobes. Results of spectroscopy and perfusion studies were suggestive of a neoplastic process.Histopathology and staining tests confirmed the diagnosis of a gliosarcoma. CONCLUSION: Primary gliosarcoma is a rare CNS tumor currently classified as a Grade IV neoplasm and a variant of glioblastoma multiforme (GBM). Epidemiology and natural history have been described as similar to that of GBM, however gliosarcoma has been found to have greater temporal lobe involvement and propensity to metastasize extracranially (3). The objective of this case report is to describe the onset, course and management of a rare case of gliosarcoma initially manifesting only with parietal signs.