Cerebral gliosarcoma: clinico-pathologic study of 8 cases

Gliosarcomas are biphasic neoplasms composed of a glioblastoma admixed to a sarcomatous component with different lines of differentiation. Histogenesis of these tumors is still discussed. Our objective is to specify clinical and pathological characteristics of this rare noeoplasm and to discuss its histogenesis. Retrospective study of eight cases of gliosarcomas diagnosed between January 1998 and December 2004. Clinical, radiological, therapeutic and follow-up data were reviewed. Histological features and immunohistochemical results were also included in this review. Five patients were male, three women with a median age of 50.7 [range 31-74 years]. Symptoms were dominated by intracranial hypertension and paralysis. The most conmon location was parietal or temporo-parietal [5 cases: 62.5%]. Pathological exam including histochemical and immunohistochemical study confirmed the diagnosis of gliosarcoma in all cases. Sarcomatous component had features of fibrosarcoma in 5 cases, osteosarcoma in 2 cases and malignant fibrous histiocytoma in 1 case. All patients were treated by surgical excision [complete in five cases and partial in three cases]. Adjuvant radiotherapy was received in three cases. One patient was lost on follow-up. Two patients died from postoperative complications and the five remaining patients died with a medium follow up of 9 months [extremes: 2-24 months]. Clinical, radiological and follow-up features of gliosarcomas share great similarities with glioblastomas. Histopathological, histochemical and inmmnohistochemical studies are helpful in accuracy diagnosis. Recent cytogenetic and molecular data support a monoclonal origin for these tumors

accessory middle cerebral artery associated with an aneurysm

An accessory middle cerebral artery [MCA] usually originates between the A1 and proximal A2 segment of the anterior cerebral artery, reaches the Sylvian fissure, and supplies the territory of the MCA. This anomaly has been associated with cerebral aneurysms and Moyamoya disease. These associations are rare. We report a case of an accessory MCA associated with an aneurysm. Knowledge and recognition of such anomalies are useful and important in the interpretation of cerebral images and during neurosurgical procedures

Cervical Ewing's sarcoma presenting as neurinoma

Considering their usual bone localisation, Ewing's sarcomas of soft tissues are rare. We report a case of a 19-year-old patient who had been suffering from cervico-brachial neuralgia followed by symptoms of progressive spinal cord compression. Magnetic resonance imaging detected a tumour at the C [7] level in the antero-lateral part of the spinal canal with an intracanal extension via an enlarged inter vertebral foramen, mimicking a neurinoma. The patient underwent an incomplete tumoural exeresis. The pathological examination yielded typical findings of Ewing's sarcoma. The patient underwent chemotherapy followed by complementary tumoural exeresis and radiotherapy. Literature review denotes the exceptional feature of the presentation. Correct and definitive diagnosis is made by pathological examination. Management of Ewing's sarcoma with the three main modalities: surgery, radiotherapy and chemotherapy increase the patient's survival