Department of Radiology and Imaging Sciences, University of Utah Health Sciences Center, Salt Lake City, UT.
Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, UT.
J Neuroimaging. 2019 Jan;29(1):126-132. doi: 10.1111/jon.12565. Epub 2018 Oct 8.
Gliosarcoma (GSC) is an intra-axial lesion which often abuts a dural margin and is composed of glial and mesenchymal elements. This lesion is considered a variant of isocitrate dehydrogenase (IDH)-wild type glioblastoma (GBM). The purpose of this study is to evaluate the imaging and molecular features of GSC in a large patient cohort.
Pathology-proved GSC cases were collected from our quaternary care center spanning the last 16 years and IDH status was documented. Older GSC cases without prior immunohistochemical testing underwent tissue block staining to obtain IDH status. When available, p53, phosphate and tensin (PTEN), MIB-1, EGFR amplification, and MGMT methylation were recorded and imaging findings tabulated. Logistic regression analyses were performed to determine correlation of molecular markers and imaging characteristics.
A total of 25 cases were identified (21 de novo, 4 post-treatment). All lesions contacted a dural, pial, or ependymal surface and were negative for an IDH R132H mutation, including postradiation GSC. In total, 16 of 16 cases showed nonamplification of EGFR/CEP7, 2 of 16 demonstrated MGMT methylation, and multiple lesions demonstrated p53 and PTEN mutations. Imaging features included areas of nodular thickening in necrotic lesions which appeared to abut the site of dural contact. There was no significant correlation of molecular markers with imaging characteristics.
GSC was IDH(-) in all cases, supporting the current understanding of this lesion being a wild-type GBM variant. Additional molecular markers demonstrated no significant correlation with imaging findings in this cohort.
神经胶母肉瘤（gliosarcoma，GSC）是一种位于脑内的病变，常与硬脑膜边缘相邻，由神经胶质和间叶成分组成。该病变被认为是异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤（glioblastoma，GBM）的一种变体。本研究的目的是在一个大型患者队列中评估 GSC 的影像学和分子特征。
从我们的四级医疗中心收集了过去 16 年中经病理证实的 GSC 病例，并记录了 IDH 状态。对于没有先前免疫组织化学检测的较老的 GSC 病例，进行组织块染色以获得 IDH 状态。当有条件时，记录 p53、磷酸和张力蛋白（phosphate and tensin，PTEN）、MIB-1、表皮生长因子受体（epidermal growth factor receptor，EGFR）扩增和 O6-甲基鸟嘌呤-DNA 甲基转移酶（O6-methylguanine-DNA methyltransferase，MGMT）甲基化，并列出影像学表现。进行逻辑回归分析以确定分子标志物和影像学特征的相关性。
共确定了 25 例病例（21 例为初发，4 例为治疗后）。所有病变均与硬脑膜、软脑膜或室管膜表面接触，且 IDH R132H 突变均为阴性，包括放疗后 GSC。16 例中有 16 例 EGFR/CEP7 无扩增，2 例有 MGMT 甲基化，多个病变有 p53 和 PTEN 突变。影像学特征包括坏死病变中出现结节性增厚区，这些区域似乎与硬脑膜接触部位相邻。在本队列中，分子标志物与影像学特征之间没有显著相关性。
所有病例的 GSC 均为 IDH（-），支持目前对该病变为野生型 GBM 变体的认识。在本队列中，其他分子标志物与影像学发现之间没有显著相关性。
