Abstract
Gliosarcoma (GS) is a rare and aggressive variant of glioblastoma (GBM), accounting for 2–8% of all GBM cases. It is characterized by biphasic histology comprising glial and sarcomatous components and carries a dismal prognosis. A 32-year-old female presented with progressive headache, vomiting, seizures, and right-sided weakness for two months. Magnetic resonance imaging revealed heterogeneously enhancing left frontal lesion with mass effect, for which patient underwent near-total surgical excision. Histopathological examination demonstrated biphasic morphology with glial and sarcomatous components, mitotic activity, giant tumor cells, and extensive necrosis. Immunohistochemistry revealed GFAP positivity in the glial component and vimentin, SMA, and weak GFAP positivity in the sarcomatous component. ATRX was retained, IDH-1 was negative, and Ki-67 index was 50%, confirming WHO grade 4 GS with smooth muscle differentiation. Despite aggressive multimodal therapy including surgery, radiotherapy, and temozolomide-based chemotherapy, the patient succumbed after three cycles, reflecting the poor prognosis associated with GS.
