Angiosarcomatous component in gliosarcoma: case report and consideration of diagnostic challenge and hemorrhagic propensity

An angiosarcomatous component in gliosarcoma may be associated with an increased intraoperative hemorrhagic risk and preoperative diagnostic challenge. We report a unique case of gliosarcoma with an angiosarcomatous component in a 61-year-old man. His brain MRI demonstrated a well-demarcated right occipital tumor with multiple flow voids and rim-like enhancement as well as intratumoral strip and nodular enhancements. He underwent a craniotomy for tumor resection. Intraoperatively, significant tumor hemorrhage required greater efforts to control intraoperative bleeding and to maintain hemostasis. Pathological examination of the tumor revealed alternating gliomatous and sarcomatous/angiosarcomatous components with intratumoral hemorrhage. He was postoperatively treated with chemoradiation. The tumor recurred at 9 months, for which the second resection was performed with similarly greater efforts to achieve hemostasis. The recurrent tumor was pathologically similar despite treatment-associated changes. Awareness of this angiosarcomatous component in gliosarcoma with the hemorrhagic risk is important for both the preoperative diagnosis and surgical management.

Multiple pathological components in gliosarcoma

Dear Editor:Our recent article"Angiosarcomatous component in Glioblastoma:case report and consideration of diagnostic challenge and hemorrhagic propensity"published in The Journal of Biomedical Research[1]demonstrated an interesting case of gliosarcoma with alternating gliomatous and angiosarcomatous components,which on imaging,displayed unique intratumorally piliform enhancement pattern and clinically,exhibited an increased tendency for intraoperative hemorrhage.Indeed,gliosarcoma may be composed of various different pathological components and may dictate the radiological features and clinical presentations that make preoperative diagnosis extremely difficult.