title: Analysis of a synchronous gliosarcoma and meningioma with long survival: A case report and review of the literature.
abstract: BACKGROUND
  The simultaneous occurrence of multiple intracranial neoplasms has been reported, especially in genetic familial syndromes and after cranial irradiation. In the absence of these etiologic factors, some reports showed simultaneous occurrence of glioblastoma and meningioma but the association between gliosarcoma and meningioma is unknown.
  
  
  METHODS
  We report a case of a 51-year-old woman with synchronous gliosarcoma and meningioma in whom extensive immunohistochemical characterization and molecular profile was performed. The gliosarcoma recurred 21 months after the first resection, reaching 3 years of overall survival. A molecular characterization of all three lesions was performed. None of the lesions showed the presence of mutations in TP53 and BRAF genes. MGMT analysis showed the presence of loss of expression associated with promoter hypermethylation in both gliosarcoma lesions. EGFR overexpression and gene amplification was found only in the recurrent gliosarcoma.
  
  
  CONCLUSIONS
  The immunohistochemistry and molecular data of this unique case, suggest the distinct clonal origin of meningioma and gliosarcoma lesions, and the association of MGMT methylation with the presumable favorable prognosis observed.
authors.affiliation: Department of Neurosurgery, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Linhares
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal ; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Olga
authors.initials: O
authors.lastname: Martinho
authors.affiliation: Department of Neurosurgery, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Carvalho
authors.affiliation: Department of Pathology, Hospital S. João, Porto, Portugal.
authors.forename: Lígia
authors.initials: L
authors.lastname: Castro
authors.affiliation: Department of Pathology, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal ; Medical Faculty of Porto University, IPATIMUP, Porto, Portugal.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Lopes
authors.affiliation: Department of Neurosurgery, Hospital S. João, Porto, Portugal ; Medical Faculty of Porto University, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Vaz
authors.affiliation: Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal ; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, S. Paulo, Brazil ; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Rui Manuel
authors.initials: RM
authors.lastname: Reis
keywords: EGFR; MGMT; gliosarcoma; long survival; meningioma; synchronous