title: Primary Cerebellar Gliosarcoma with Extracranial Metastases: An Orphan Differential Diagnosis.
abstract: BACKGROUND
  Gliosarcomas are rare, malignant primary brain tumors, most commonly located in the temporal lobe, that contain both glial and mesenchymal elements. Gliosarcomas located within the cerebellum are exceedingly rare. The previously unreported finding of a cerebellar gliosarcoma concurrently with an extracranial metastasis to the lungs is discussed here.
  
  
  METHODS
  A 57-year-old man presented with a 3-month history of chest pain, weight loss, headaches, and vomiting. Physical examination revealed a left cerebellar dysfunction, and the radiological work-up revealed a 6 × 6-cm right apical pulmonary tumor and a 4 × 3.5 × 3.8-cm peripherally enhancing left cerebellar mass. On the basis of a smoking history in the setting of a lung lesion and cerebellar mass, the presumptive diagnosis was primary lung cancer with metastasis to the cerebellum. Gross total resection of a firm pseudo-encapsulated cerebellar mass was performed. The microscopic features and the immunohistochemical profile confirmed the diagnosis of Gliosarcoma. The thoracic lesion was removed subsequently, and pathology confirmed it as an extracranial metastasis from the cerebellar gliosarcoma. Adjuvant radiation and chemotherapy were then administered. No clinical or radiographic evidence of recurrence was observed during one year of follow-up monitoring.
  
  
  CONCLUSIONS
  To the best of our knowledge, a primary infratentorial gliosarcoma with extracranial metastases has not been previously described.
authors.affiliation: Department of Neurosurgery, Fattouma Bourguiba University Hospital-University of Medicine of Monastir, Monastir, Tunisia. Electronic address: atefbn@hotmail.fr.
authors.forename: Atef
authors.initials: A
authors.lastname: Ben Nsir
authors.affiliation: Department of Neurosurgery, The Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Quoc-Anh
authors.initials: QA
authors.lastname: Thai
authors.affiliation: Department of Pathology, La Rabta University Hospital-Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
authors.forename: Alia Zhani
authors.initials: AZ
authors.lastname: Kassar
authors.affiliation: Department of Neurosurgery, The Tunisian National Institute of Neurology-Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
authors.forename: Imed
authors.initials: I
authors.lastname: Ben Said
authors.affiliation: Department of Neurosurgery, The Tunisian National Institute of Neurology-Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
authors.forename: Hafedh
authors.initials: H
authors.lastname: Jemel
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D018316:Gliosarcoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D006801:Humans; D015192:Infratentorial Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016896:Treatment Outcome
keywords: Cerebellum; Computed tomography; Glioblastoma; Gliosarcoma; Infratentorial tumor; Magnetic resonance imaging; Metastases