Gliosarcoma: A Rare Mimic of Glioblastoma Deciphered on Histopathology - A Case Report
DOI:
https://doi.org/10.21276/apalm.3934Keywords:
gliosarcoma, glioblastoma, high grade gliomas, reticulin, immunohistochemistry, vimentin, GFAPAbstract
Introduction: Gliosarcoma is a rare but clinically significant high grade malignant tumor considered as a variant of glioblastoma. However, inspite of resembling glioblastoma in its clinical course, gliosarcoma is known to show a distinct and characteristic biphasic architecture consisting of both mesenchymal (sarcomatous) and glial components making it distinct from glioblastomas on histopathology.
Case Presentation: We present a case of a 56 year old female who presented with chief complaints of inability to speak and seizures. While clinical and radiological examination pointed towards a broad differential of a high grade glioma, strategic use of histopathological and immunohistochemical examination led to a definitive diagnosis of a rare but high grade Gliosarcoma.
Conclusion: Our case highlights the importance of recognizing gliosarcoma as a separate entity on histopathology by highlighting its sarcomatous and mesenchymal components with strategic use of special stains such as reticulin and immunohistochemical markers such as GFAP and Vimentin. This is essential for predicting patient outcome and clinical course of the disease thus aiding the refinement of therapeutic strategies.
References
1. Meis JM, Ho KL, Nelson JS. Gliosarcoma: a histologic and immunohistochemical reaffirmation. Mod Pathol. 1990;3(1):19-24. PMID: 1691244.
2. Stroebe H. Uber Entstehung und Bau der Gehirngliome. Beitr Pathol Anat Allg Pathol. 1895;18:405-85.
3. Borota OC, Scheie D, Bjerkhagen B, Jacobsen EA, Skullerud K. Gliosarcoma with liposarcomatous component, bone infiltration and extracranial growth. Clin Neuropathol. 2006;25(4):200-3. PMID: 16848143.
4. Morantz RA, Feigin I, Ransohoff J 3rd. Clinical and pathological study of 24 cases of gliosarcoma. J Neurosurg. 1976;45(4):398-408. doi:10.3171/jns.1976.45.4.0398.
5. Burger PC, Scheithauer BW. Atlas of tumor pathology. Tumors of the central nervous system. Series 3, Fascicle 10. Washington, DC: Armed Forces Institute of Pathology; 1993. p. 68-70.
6. Han SJ, Yang I, Otero JJ, Ahn BJ, Tihan T, McDermott MW, Berger MS, Chang SM, Parsa AT. Secondary gliosarcoma after diagnosis of glioblastoma: clinical experience with 30 consecutive patients. J Neurosurg. 2010;112(5):990-996. doi:10.3171/2009.9.JNS09931.
7. Smith DR, Wu CC, Saadatmand HJ, Isaacson SR, Cheng SK, Sisti MB, Bruce JN, Sheth SA, Lassman AB, Iwamoto FM, Wang SH, Canoll P, McKhann GM 2nd, Wang TJC. Clinical and molecular characteristics of gliosarcoma and modern prognostic significance relative to conventional glioblastoma. J Neurooncol. 2018;137(2):303-311. doi:10.1007/s11060-017-2718-z.
8. Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231-1251. doi:10.1093/neuonc/noab106.
9. Cerame MA, Guthikanda M, Kohli CM. Extraneural metastasis in gliosarcoma: a case report and review of literature. Neurosurgery. 1985;17(3):413-418. doi:10.1227/00006123-198509000-00021.
10. Ehrenreich T, Devlin JF. A complex of glioblastoma and spindle cell sarcoma with pulmonary metastasis. Arch Pathol. 1958;66(4):536-549. PMID: 13582313.
11. Garret R. Gliosarcoma and fibrosarcoma of the brain with extracranial metastasis. Cancer. 1958;11(5):888-894. doi:10.1002/1097-0142(195809/10)11:5<888::aid-cncr2820110505>3.0.co;2-m.
12. Yi X, Cao H, Tang H, et al. Gliosarcoma: a clinical and radiological analysis of 48 cases. Eur Radiol. 2019;29(1):429-438. doi:10.1007/s00330-018-5398-y.
13. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987-996. doi:10.1056/NEJMoa043330.
14. Boerman RH, Anderl K, Herath J, Borell T, Johnson N, Schaeffer-Klein J, et al. The glial and mesenchymal elements of gliosarcomas share similar genetic alterations. J Neuropathol Exp Neurol. 1996;55(9):973-981. doi:10.1097/00005072-199609000-00004.
15. Riedl J, Preusser M, Nazari PMS, Posch F, Panzer S, Marosi C, et al. Podoplanin expression in primary brain tumors induces platelet aggregation and increases risk of venous thromboembolism. Blood. 2017;129(13):1831-1839. doi:10.1182/blood-2016-06-720714.
16. Gardiner C, Harrison P, Belting M, Böing A, Campello E, Carter BS, et al. Extracellular vesicles, tissue factor, cancer and thrombosis – discussion themes of the ISEV 2014 Educational Day. J Extracell Vesicles. 2015;4:26901. doi:10.3402/jev.v4.26901.
17. Kumar P, Singh S, Kumar P, Krishnani N, Datta NR. Gliosarcoma: an audit from a single institution in India of 24 post-irradiated cases over 15 years. J Cancer Res Ther. 2008;4(4):164-168. doi:10.4103/0973-1482.44286.
18. Beaumont TL, Kupsky WJ, Barger GR, Sloan AE. Gliosarcoma with multiple extracranial metastases: case report and review of the literature. J Neurooncol. 2007;83(1):39-46. doi:10.1007/s11060-006-9295-x.
19. Frandsen S, Broholm H, Larsen VA, Grunnet K, Kosteljanetz M, Poulsen HS, et al. Clinical characteristics of gliosarcoma and outcomes from standardized treatment relative to conventional glioblastoma. Front Oncol. 2019;9:1425. doi:10.3389/fonc.2019.01425.
20. Luo M, Yang J, Sun J, Wang F, Chai X. Primary gliosarcoma with widespread extracranial metastases—spatiotemporal morphological variation. Chin Neurosurg J. 2022;8(1):22. doi:10.1186/s41016-022-00285-1.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Fatima Qaiser Naqvi, Bushra Siddiqui

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).

