Pathologic spectrum of primary central nervous system sarcomas: A retrospective Tertiary care centre study

Primary central nervous system (CNS) sarcomas are rare, heterogeneous mesenchymal neoplasms that account for less than 1% of CNS tumours and pose significant diagnostic challenges due to their morphological diversity and overlap with other CNS neoplasms. This retrospective study analysed 65 cases of primary CNS sarcomas diagnosed over a 12-year period (2014-2025) at a tertiary care centre. Clinical, demographic, and radiological details were retrieved from institutional records, and all cases were reviewed using an integrated diagnostic approach incorporating histopathology, immunohistochemistry, and molecular studies, including fluorescence in situ hybridization and reverse transcriptase polymerase chain reaction, and classified according to the 2021 World Health Organization Classification of Tumours of the Central Nervous System. The cohort showed a male predominance (male:female = 1.3:1), with a mean age of 28.6 years (median: 22 years), and predominantly affected children and young adults. Tumours most frequently involved the spinal and paraspinal regions (60%, n = 39). Ewing sarcoma was the most common subtype (58.5%), followed by solitary fibrous tumour (10.8%) and malignant peripheral nerve sheath tumour (7.7%), while rhabdomyosarcoma, alveolar soft part sarcoma, angiosarcoma, and other rare sarcomas were encountered less frequently. Accurate diagnosis required careful correlation of clinical and radiological findings with morphology, immunophenotype, and molecular alterations. Primary CNS sarcomas comprise a diverse group of tumours with distinct pathological and molecular features, and precise classification requires integrating demographic, radiological, histopathological, immunohistochemical, and molecular findings for optimal diagnosis and patient management.