PEDIATRIC GLIOSARCOMA- CASE REPORT AND REVIEW OF LITERATURE

Abstract

Aim- To report a case of Pediatric Gliosarcoma.
Case history- A 11 year old
boy was referred to the Neurology department
for complaints of progressive
weakness of left upper and lower limb
and deviation of face to right side since 2
month and headache and vomiting for 2
days. Patient had a past history one and
a half years ago of convulsions of left
lower limb and MRI Brain had suggested
a granulamatous lesion in right Frontoparietal
region 1x1.4 cms with edema.
Patient was diagnosed as Neurocysticercosis
and treated with Albendazole and
Phenytoin and was asymptomatic for a
year. Examination of the patient revealed
a KPS 70 as patient needed support
while walking, left hemiparesis (power 3
by 5)and left UMN facial palsy and increased
ICT. CT Brain showed an irregular
heterodense mass in right Frontoparietal
region 6x5 cms with midline shift
and significant edema. A subtotal excision
was undertaken. Pathological review
revealed a biphasic tumour with increased
cellularity, mitotic index and necrosis
with malignant spindle cells in
Herring bone pattern. IHC showed diffuse
positivity for Vimentin and focal for GFAP
while SMA was negative. A diagnosis of
Gliosarcoma - a rare variant of glioblastoma
with sarcomatous elements- was
made and the patient was treated with Radiotherapy
54 Gy (50.4 Gy with 3.6 Gy
boost) with concomitant temozolamide 100
mg on all 42 days and is currently on adjuvant
temozolamide 250 mg for 4 days a
month. Patient is able to walk without support
but facial asymmetry persists and left
limb power is 4 by 5.