Unusual evolution and computerized tomographic appearance of a gliosarcoma.
A patient with a remote infarct, seizures, mild hemiparesis, and dysphasia became obtunded over four months and died. Computerized tomography (CT) over 5 years showed a consistent, large, wedge-shaped left hemisphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cerebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspect that the unusual CT appearance of the lesion was likely caused by multiple pathologies: a low grade glioma transforming into a gliosarcoma that was able to spread throughout the area of infarct encephalomalacia without revealing a typical CT appearance of mass effect. The patient's brief period of deterioration probably coincided with transformation of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.
Preul
M C
MC
Division of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, PQ, Canada.
Espinosa
J A
JA
Tampieri
D
D
Carpenter
S
S
D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D005158:Facial Paralysis / Q000209:etiology; D017809:Fatal Outcome; D005500:Follow-Up Studies; D018316:Gliosarcoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed