Jafari Elham, Didehban Shiva, Dabiri Shahriar, Mofid Behshad
Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran.
Clinical Research Unit, Shahid Bahonar Academic Center, Kerman University of Medical Sciences, Kerman, Iran.
Iran J Pathol. 2021 Winter;16(1):84-89. doi: 10.30699/ijp.2020.122606.2330. Epub 2020 Oct 10.
A heterogeneous group of CNS tumors are characterized by mixed neuroepithelial and mesenchymal features. Glial tumors manifesting this phenomenon are referred to as gliosarcoma. These tumors are usually mistaken for cerebral metastases or meningioma at operation. Their histological studies have revealed an admixture of gliomatous and sarcomatous tissues, which leads to a biphasic pattern. The mesenchymal component can present in different forms such as fibrosarcoma, undifferentiated pleomorphic sarcoma, chondro-osteogenic, and myogenic differentiation, as well as angiosarcomatous and liposarcomatous types. Squamous differentiation, formations and glandular structures may also be displayed. Herein, we report a rare case who was admitted to the emergency room with decreased consciousness resembling methadone poisoning. Clinical work-up showed a temporoparietal mass on radiological investigation. Histopathological evaluation of the brain mass revealed a gliosarcoma with adenoid formations and a mesenchymal component, which manifested as chondrosarcomatous differentiation. Immunohistochemical studies confirmed the histologic diagnosis through positivity for EMA, GFAP, S100, and vimentin expression in different components.
一组异质性的中枢神经系统肿瘤具有神经上皮和间充质混合特征。表现出这种现象的胶质肿瘤被称为胶质肉瘤。这些肿瘤在手术时通常被误诊为脑转移瘤或脑膜瘤。它们的组织学研究显示存在胶质瘤组织和肉瘤组织的混合，形成双相模式。间充质成分可以呈现不同形式，如纤维肉瘤、未分化多形性肉瘤、软骨-骨源性和肌源性分化，以及血管肉瘤和脂肪肉瘤类型。也可能出现鳞状分化、形成物和腺性结构。在此，我们报告一例罕见病例，该患者因意识减退被紧急送往急诊室，类似美沙酮中毒。临床检查显示影像学检查发现颞顶叶肿块。对脑肿块的组织病理学评估显示为具有腺样结构和间充质成分的胶质肉瘤，间充质成分表现为软骨肉瘤样分化。免疫组织化学研究通过不同成分中EMA、GFAP、S100和波形蛋白表达呈阳性证实了组织学诊断。
