Brain Pathology Case of the Month - October 1998

Contributed by Lise Mette Gjerdrum, MD and Marie Bojsen-Møller, MD
  University Institute of Pathology, Aarhus Kommunehospital, Aarhus, Denmark


A previously healthy 61-year-old man was admitted in January 1997 with a 6-month history of gradually progressive weakness in the left arm and leg. Neurological examination revealed a left-sided facial nerve paresis and extremity weakness. The remaining examination, laboratory values, chest x-ray and abdominal ultrasound scanning showed no gross abnormalities. A contrast enhanced cranial CT-scan demonstrated a 3 cm large tumor of mixed density in the right temporo-parietal region with extensive surrounding edema and midline shift. During craniotomy the tumor was found to be cystic, necrotic and could not be totally extirpated. The microscopic findings were consistent with a gliosarcoma. After surgery the patient received brain radiation therapy. Approximately 6 months later he consulted his dentist with an oral tumor, and shortly afterwards a dermal mass was removed from the lateral corner of his right eye. Both tumors exhibited a sarcoma pattern by microscopy. A chest x-ray at that time revealed multiple pulmonary metastases. A pulmonary biopsy was not performed. Chest radiation therapy was given, but the patient`s condition deteriorated, and he died at home in September 1997. An autopsy was not performed.



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