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Unusual Evolution and Computerized Tomographic Appearance of a Gliosarcoma

Published online by Cambridge University Press:  18 September 2015

Mark C. Preul ,
Jose A. Espinosa ,
Donatella Tampieri  and
Stirling Carpenter
Mark C. Preul
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
Jose A. Espinosa
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
Donatella Tampieri*
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
Stirling Carpenter
Affiliation:
Divisions of Neurosurgery, Neuroradiology and Neuropathology, Montreal Neurological Institute and Hospital, McGill Universit, Montrel
*
Division of Neuroradiology, Montreal Neurological Hospital, 3801 University Street, Montreal. PQ, Canada H3A 2B4
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Abstract:

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A patient with a remote infarct, seizures, mild hemiparesis, and dysphasia became obtunded over four months and died. Computerized tomography (CT) over 5 years showed a consistent, large, wedge-shaped left hemisphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cerebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspect that the unusual CT appearance of the lesion was likely caused by multiple pathologies: a low grade glioma transforming into a gliosarcoma that was able to spread throughout the area of infarct encephalomalacia without revealing a typical CT appearance of mass effect. The patient's brief period of deterioration probably coincided with transformation of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.

Résumé:

RÉSUMÉ:

Un patient présentant un infarctus ancien, des convulsions, une légère hémiparésie et une dysphasie, a développé de la confusion quatre mois avant son décès. La tomodensitométrie sériée sur 5 ans a montré une zone étendue, de forme triangulaire, hypodense, sans calcification centrale, mais sans aspect de masse, à l'hémisphère gauche. Cette image a été interprétée comme étant un infarctus dans le territoire de l'artère cérébrale moyenne. L'autopsie du cerveau a révélé que toute la zone qui avait l'apparence d'un infarctus à la tomodensitométrie était en fait un gliosarcome. Nous soupçonnons que l'aspect inhabituel de la lésion à la tomodensitométrie était dû à des pathologies multiples: un gliome évoluant à bas bruit qui s'est transformé en gliosarcome et qui a envahi la zone d'encéphalomalacie post-infarctus, sans produire d'aspect de masse à la tomodensitométrie. La détérioration rapide du patient a probablement coïncidé avec la transformation de la tumeur en gliosarcome. Nous revoyons les caractéristiques tomodensitométriques variables des gliosarcomes.

Type
Articles
Information
Canadian Journal of Neurological Sciences , Volume 21 , Issue 2 , May 1994 , pp. 141 - 145
Copyright
Copyright © Canadian Neurological Sciences Federation 1994

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