Video - Gliosarcoma in Adults: A Ten-Case Single-Center Analysis of Clinical Presentation, Imaging, and Pathology

Background and Objective: Gliosarcoma (GS) is a rare and aggressive variant of glioblastoma (GB), accounting for 1–2% of GB cases. Our objective is to analyse the clinical, radiological, histopathological, and immunohistochemical characteristics of primary gliosarcoma in a single-center cohort and compare findings with existing literature. Material and Methods: We retrospectively reviewed ten adult patients with histologically confirmed primary gliosarcoma (GS) diagnosed between 2012–2021 at “Prof. Dr. N. Oblu” Emergency Clinical Hospital, Iași, Romania. Data extracted included demographics, clinical presentation, magnetic resonance imaging (MRI) features, surgical management, pathology, and immunohistochemistry. Results: Mean age at diagnosis was 64.1 years (range 47–79), with male predominance (male:female ratio = 6:4). Common symptoms included speech disturbances (30%), seizures (20%), and headache (20%), with a median symptom duration of 7 days. Tumours were supratentorial, primarily frontal (40%) or temporal (10%), with 50% involving multiple lobes. Histologically, all cases demonstrated biphasic glial-sarcomatous architecture; 40% showed giant-cell glioblastoma features. Immunohistochemistry revealed glial fibrillary acidic protein (GFAP) and oligodendrocyte transcription factor 2 (Olig2) positivity in glial areas, vimentin positivity in both components, isocitrate dehydrogenase 1 (IDH1) wild-type status, alpha thalassemia/mental retardation syndrome X-linked (ATRX) positivity, intermediate Ki-67 (~21%), and variable p53 expression. Conclusion: Primary gliosarcoma is an aggressive central nervous system (CNS) tumour with characteristic biphasic morphology, frequent dural contact, and meningioma-mimic imaging. Accurate diagnosis relies on histopathology, guiding maximal safe resection and adjuvant chemoradiation.