A clinico-pathological study of 29 cases of gliosarcoma with special reference to two unique variants

In the present series, the clinical and pathological features of 29 patients of gliosarcoma diagnosed over a 12 yr period (1984-1995) are reviewed. Gliosarcomas constituted 0.48 per cent of all intracranial tumours and 4.9 per cent of all cases of glioblastoma multiforme. Most patients (68.6%) with these tumours were above 40 yr of age. However, an interesting observation in the present series was that 10.3 per cent of patients (3/29) were below 14 yr of age, the youngest being 9 months. A male preponderance was noted and the temporal lobe was involved in 55 per cent patients. Histologically, in 25 of the 29 tumours, the sarcomatous component had the appearance of fibrosarcoma. Tumours from 4 patients were unique in that one showed rhabdomyoblastic differentiation in the mesenchymal areas as confirmed by immunohistochemical stains and electron microscopy (gliomyosarcoma). In three others, the neoplastic spindle cell component was closely associated with discrete areas of osteogenic sarcoma. Follow up in 12 patients (including the 4 patients with unique variants) revealed poor outcome similar to glioblastomas. All of them died within 1 month to 1.5 yr following surgery and postoperative radiotherapy. This study possibly represents the most comprehensive and largest series of gliosarcomas being reported from India.