Virtual Microscope
A 60 year-old man with recurrent intra-axial brain tumor
Jiang Qian, M.D., Ph.D.
Department of Pathology, Albany Medical College, Albany, NY.
Clinical Information: The patient was a 60 year-man. He had a right intra-axial frontal-parietal tumor that was removed three months ago. MRI demonstrated recurrence of tumor and the slide presented with the virtual microscope is the recurrent tumor.
Diagnosis: Gliosarcoma with perdominantly osteosarcoma differentiation.
Pathology: The tumor is composed of a spindle cell tumor with high cellularity. Necrosis is common and the tumor cells have high level of pleomorphism. Interestingly, there is extensive osteoid differentiation. There are very few areas that suggest glioma. In the peripheray, the high cellular area is well demarcated with the parenchymal. In these brain parenchymal areas, there are some large atypical cells with high level of atypia. These nuclei probably represent residual glial component of the neoplasm.
Comment: This is a very unusual case. Without the clinical information of a prior gliosarcoma, metastatic osteosarcoma may appear to be a very likely diagnosis.