IDH1-mutant primary intraventricular gliosarcoma: Case report and systematic review of a rare location and molecular profile

Leonardo Jose Monteiro de Macedo Filho; Esther Grangeiro Barreto; Paulo Levi Bezerra Martins; Euler Nicolau Sauaia Filho; Gunter Gerson; Lucas Alverne Freitas de Albuquerque

doi:10.25259/SNI_586_2020

IDH1-mutant primary intraventricular gliosarcoma: Case report and systematic review of a rare location and molecular profile

Surg Neurol Int. 2020 Nov 6:11:372. doi: 10.25259/SNI_586_2020. eCollection 2020.

Authors

Leonardo Jose Monteiro de Macedo Filho¹, Esther Grangeiro Barreto¹, Paulo Levi Bezerra Martins¹, Euler Nicolau Sauaia Filho¹, Gunter Gerson², Lucas Alverne Freitas de Albuquerque²

Affiliations

¹ Health Science Center, University of Fortaleza, Ceara, Brazil.
² Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceara, Brazil.

Abstract

Background: Gliosarcoma (GS) is classified as an IDH-wild-type variant of glioblastoma (GBM). While GS is already an unusual presentation of GBM, IDH1-mutant cases are especially rare. We present an IDH1-mutant primary intraventricular GS case report and a systematic review of the molecular profile in GS correlating to the prognostic and pathogenesis of IDH1/2 mutations.

Case description: A 44-years-old man presented with ongoing fatigue symptoms and a new-onset intense occipital headache. The patient complained of memory loss, dyscalculia, and concentration difficulties. An MRI revealed a bihemispheric intraventricular mass crossing the midline through the corpus callosum and infiltrating the trigone of the lateral ventricles, hypointense, and hyperintense on the T1- and T2-weighted image. We performed a microsurgical resection with a transparietal transsulcal approach; however, the contralateral mass was attached to vascular structures and we decided to reoperate the patient in another moment. The histopathological study showed a Grade IV tumor and the immunohistochemistry confirmed the diagnosis of GS. The patient presented progressive neurologic decline and died 45 days after the surgical approach.

Conclusion: We did two systematic reviews studies from PubMed, EMBASE, MEDLINE, Cochrane, and SCOPUS databases, and included molecular and intraventricular studies of GS. We performed further meta-analysis using OpenMetaAnalyst™ software. We conducted a forest plot with the molecular profile of GS. When correlated IDH1 mutation versus tp53 mutation, we found an odds ratio (OR) of 0.018 (0.005-0.064) and P < 0.001. Moreover, we compared IDH1 mutation versus MGMT methylation (P = 0.006; OR = 0.138 [0.034-0.562]). The studies evaluating the molecular profile in GS prognostics are often extended from all GBMs despite specifics GBM variants (i.e., GS). We found a correlation between IDH1 mutation expression with tp53 and MGMT expression in GS, and future studies exploring this molecular profile in GS are strongly encouraged.

Keywords: Case report; Cerebral ventricle neoplasms; Gliosarcoma; Human IDH1 protein; Systematic review.

Publication types

Case Reports