PEDIATRIC GLIOSARCOMA- CASE REPORT AND REVIEW OF LITERATURE

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.