title: A nonradiated grade II glioma that underwent delayed malignant transformation to a gliosarcoma with meningeal growth and dissemination.
abstract: BACKGROUND
  Secondary gliosarcomas are rare tumors, especially those arising from a World Health Organization (WHO) grade II glioma not irradiated. We report a case with subtotal resection for a WHO grade II oligoastrocytoma, without adjuvant treatment, whose metaplastic transformation into gliosarcoma suddenly occurred 4 years later with meningeal dissemination. We show a favorable outcome after therapeutic management of this rare entity.
  
  
  METHODS
  A 46 year-old woman underwent surgery for a right premotor WHO grade II oligoastrocytoma discovered incidentally. Because of a subtotal resection with only 1 cc of residue, no complementary therapy was given, and the patient enjoyed a normal life for 4 years. In the meantime, the magnetic resonance images performed every 6 months showed a very low growth rate. Suddenly, the tumor switched toward a gliosarcoma profile with meningeal dissemination.
  
  
  RESULTS
  Reoperation, radiotherapy, and chemotherapy were performed, enabling a control of the disease with 15 months of follow-up (i.e., with radiologic shrinkage of the multiple lesions and preservation of quality of life).
  
  
  CONCLUSIONS
  A delayed sarcomatous transformation can acutely occur with a low proliferation index in a nonirradiated WHO grade II oligoastrocytoma. Furthermore, an aggressive therapeutic strategy can allow control of secondary gliosarcomas, even in cases of leptomeningeal spreading.
authors: Department of Neurosurgery, CHU Nancy, Nancy, France.
authors: Fabien
authors: F
authors: Rech
authors: Department of Neuropathology, CHU de Montpellier, Montpellier, France.
authors: Valerie
authors: V
authors: Rigau
authors: Department of Neurooncology, ICM, Montpellier, France.
authors: Michel
authors: M
authors: Fabbro
authors: Department of Neurooncology, ICM, Montpellier, France.
authors: Christine
authors: C
authors: Kerr
authors: Department of Neuropathology, CHU Nancy, Nancy, France.
authors: Guillaume
authors: G
authors: Gauchotte
authors: Department of Neurooncology, CHU Poitiers, Poitiers, France.
authors: Luc
authors: L
authors: Taillandier
authors: Department of Neurosurgery, Montpellier University Medical Center, Montpellier, France.
authors: Hugues
authors: H
authors: Duffau
mesh_terms: D001254:Astrocytoma / Q000473:pathology* / Q000601:surgery; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D005260:Female; D018316:Gliosarcoma / Q000473:pathology* / Q000556:secondary; D006801:Humans; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000556:secondary; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D016896:Treatment Outcome