Gliosarcoma: A Very Rare Biphasic Histopathological Engima Associated with Very Poor Prognostic Parameters

Gliosarcoma (GS) is rare type of brain tumour characterised by a combination of glial and mesenchymal elements. It is a sporadic and aggressive malignancy, categorised as a variant of Glioblastoma with an Isocitrate Dehyrogenase (IDH) wild-type phenotype. These tumours generally present as well-defined masses and are most frequently observed in adults between the ages of 40 and 60 years, with a slight predominance in males. Common clinical features include focal neurological impairments such as hemiparesis and aphasia, often accompanied by tumour-associated oedema that contributes to elevated intracranial pressure. Due to the rarity of the condition, existing knowledge is primarily based on limited published reports. This report discusses a 57-yearold male who presented to the Emergency Department after experiencing a six-day progression of weakness affecting both the left upper and lower limbs, ultimately leading to significant mobility issues and difficulty walking. However, there was no history of loss of consciousness or vomiting. Upon hospital arrival, on clinical assessment, the patient was found to be drowsy but responsive, with both pupils irregularly dilated. A detailed examination revealed impaired balance and coordination, gait disturbance, numbness and tingling on the left-side of the body, as well as weakness in the left limbs and tongue, contributing to slurred speech and a stuporous state. Following the initial clinical evaluation,Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans were recommended. A CT scan revealed a hetero-dense, intra-axial solid-cystic lesion with relatively well-defined margins located in the right frontal lobe, measuring 4.6×5.0×5.5 cm (craniocaudal×transverse×anteroposterior). The mass was associated with surrounding vasogenicoedema, causing a mass effect on nearby sulci and resulting in compression of the frontal and temporal horns, as well as the body of the right lateral ventricle. MRI findings corroborated the CT results, additionally highlighting a dominant necrotic component within the lesion. These imaging features strongly suggested a brain tumour, with differential diagnoses including highgrade astrocytoma and GS. Surgical management was promptly initiated, and a complete tumour resection was performed via a right Fronto-Temporo-Parietal (FTP) craniotomy. Subsequent histopathological and immunohistochemical analysis confirmed the diagnosis of GS. The patient’s family member consent was taken verbally before reporting this case in this current literature. Hence, we are reporting this rare entity to add to the literature and to be considered in the differential diagnosis of high grade malignant glial tumours as GS holds worse prognosis compared to Glioblastoma due to its rapid metastasis.