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Li Y, Peng Q, Jiang N, Molloy DP, Zeng C, Wu Q. Computed tomography imaging features of malignant 'triton' tumor to facilitate its clinical diagnosis: report of two cases. BMC Med Imaging 2022; 22:125. [PMID: 35836141 PMCID: PMC9284860 DOI: 10.1186/s12880-022-00848-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 07/01/2022] [Indexed: 11/21/2022] Open
Abstract
Background Malignant ‘triton’ tumor is an extremely rare subtype of malignant periphery nerve sheath tumors. Clinical diagnosis of malignant triton tumor is difficult before surgery due to its low incidence and the lack of knowledge. Therefore, to describe and summarize the CT imaging characteristics of malignant triton tumor is of great assistance for early and preoperative diagnosis. Case presentation Two cases suspected of MTT by CT scan before operation were closely observed. The diagnosis of malignant triton tumor was eventually confirmed by immunochemical assay, which verified speculation of CT scans. Huge, irregular, well-circumscribed lobulated mass-like shadows can be observed from these patients by CT scans. Besides, heterogeneity of density within the body of tumor was well-established by CT scans, together with linear septum. Meanwhile, CT scans demonstrated that calcifications were remarkable at the margin of tumor body. Conclusions Some CT image features from two cases were presented as a reference for the preoperative consideration of MTT: (i) enormity of mass-like shadow; (ii) presence of well-circumscribed lobulated shape; (iii) septum within the well-defined mass accompanied with hemorrhage, necrosis and cystic changes as well as calcification, especially within neurofibromatosis type 1 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-022-00848-9.
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Affiliation(s)
- Yuan Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100010, China.,Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Qiling Peng
- School of Basic Medical Science, Chongqing Medical University, Chongqing, 400016, China
| | - Ning Jiang
- Department of Pathology, Chongqing Medical University, Chongqing, 400016, China
| | - David P Molloy
- School of Basic Medical Science, Chongqing Medical University, Chongqing, 400016, China
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| | - Qingchen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Bins RB, Pinzon CE, da Silva Pereira LD, Bertuol M, Isolan PMBS, Takamatu EE. Malignant triton tumor of the kidney in a child: A case report. Int J Surg Case Rep 2021; 85:106252. [PMID: 34358962 PMCID: PMC8350500 DOI: 10.1016/j.ijscr.2021.106252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Malignant triton tumor (MTT) is an extremely rare variant of the malignant peripheral nerve sheath tumors (MPNSTs) with rhabdomyosarcomatous differentiation, which was first described in 1932 by Mason. MTT affects, in most cases, patients under 35 years of age, and it is usually manifested as a mass that may or not be painful. However, the incidence in pediatric patients is atypical. This tumor presents an aggressive course and limited survival rate, and the prognosis is different between individuals with or without a concomitant diagnosis of neurofibromatosis type 1 (NF1). Currently, the recommended treatment is surgical resection, and adjuvant chemotherapy and radiotherapy, but its efficacy is not yet clear. Presentation of the case A 13-year-old female patient was referred to the pediatric oncology service due to the presence of an abdominal mass and weight loss, initially diagnosed with Wilms' tumor. After extensive investigation, surgical resection, and immunohistopathological evaluation, the diagnosis of malignant triton tumor was confirmed. The patient also underwent cycles of chemotherapy after resection, and is currently awaiting immunotherapy. Discussion and conclusion Malignant triton tumor is extremely rare and difficult to diagnose, especially in children or young people, age groups in which the incidence of the disease is even lower. This may be the reason it is rarely suspected, and it was a great challenge for the clinical care team. It is essential to consider and investigate this possibility of differential diagnosis, as patients diagnosed with this malignant tumor have a low survival rate and poor prognosis. Malignant triton tumor (MTT) is an extremely rare histological subtype of MPNSTs. MTT is an MPNST with rhabdomyosarcomatous differentiation. MTT is an extremely rare type of neoplasia, especially in pediatric patients. The kidney is an uncommon growth site of MTT. MTT presents a complex anatomopathological and immunohistochemical diagnosis.
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Affiliation(s)
- Rafael Bittencourt Bins
- Medical School of Universidade Federal do Rio Grande do Sul, 2400, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil; Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil.
| | - Carlos Eduardo Pinzon
- Medical School of Universidade Federal do Rio Grande do Sul, 2400, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil; Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil.
| | - Leonardo Dantas da Silva Pereira
- Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil; Division of Pediatric Surgery, Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil.
| | - Marina Bertuol
- Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil; Division of Pediatric Surgery, Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil.
| | - Paola Maria Brolin Santis Isolan
- Medical School of Universidade Federal do Rio Grande do Sul, 2400, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil; Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil; Division of Pediatric Surgery, Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil.
| | - Eliziane Emy Takamatu
- Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil; Division of Pediatric Surgery, Hospital de Clínicas de Porto Alegre, 2350, Ramiro Barcelos St, Porto Alegre, RS 90035-903, Brazil.
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Elbardesy H, Gul R, Bennett M, Power DG. Malignant triton tumour (MTT) of the lung with metastasis to the proximal femur. BMJ Case Rep 2021; 14:14/2/e237086. [PMID: 33542007 PMCID: PMC7868192 DOI: 10.1136/bcr-2020-237086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 65-year-old female patient has a history of malignant triton tumour of the right upper lobe of the lung. She underwent right upper lobectomy and lymphadenectomy in May 2018. She presented in November 2019 with pathological fracture of the left proximal femur. It was not associated with neurofibromatosis. We decided to do an excisional biopsy of the mass and proximal femoral replacement followed by radiotherapy. Four months later, she presented with local recurrence. We organised a multidisciplinary team between the orthopaedic, histopathology and oncology teams. Then, we decided to treat her with chemotherapy. After 2 months of follow-up, she responded well to the chemotherapy with no further deterioration of her condition.
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Affiliation(s)
| | - Rehan Gul
- Orthopaedics, Cork University, Cork, Ireland
| | | | - Derek G Power
- Medical Oncology, Cork University Hospital Group, Cork, Ireland
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Tsagozis P, Gaston CL, Haglund F, Balko J, Sumathi V, Grimer R, Parry M. The importance of surgical margins in malignant Triton tumour of the trunk and extremities. Oncol Lett 2020; 21:120. [PMID: 33376551 DOI: 10.3892/ol.2020.12381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/21/2020] [Indexed: 11/05/2022] Open
Abstract
Malignant Triton tumour (MTT) is a rare variant of malignant peripheral nerve sheath tumour with partial rhabdomyosarcomatous differentiation. To the best of our knowledge, the importance of the surgical resection margins on the outcome of patients with MTT is unknown. The present study is a retrospective review of 24 patients treated for MTT of the trunk and the extremities between 1997 and 2015 in two institutions. The association of surgical margins with overall and tumour recurrence-free survival was analysed. Furthermore, the typical morphological and immunohistochemical characteristics of the tumour were described. In patients treated with curative intent (17/24), a surgical margin exceeding 1 mm was significantly associated with better overall survival and local recurrence-free survival. The oncological outcome was however poor, with only 28% of patients surviving at 5 years. Histopathologically, necrosis was a common feature, and most tumours displayed focal positivity for S100 protein and focal or strong positivity for desmin. The present results highlight the aggressive behaviour of MTTs and underline the importance of adequate surgical treatment.
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Affiliation(s)
- Panagiotis Tsagozis
- The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK.,Musculoskeletal Tumour Service, Karolinska University Hospital, 17176 Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Czar Louie Gaston
- The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK.,University of the Philippines, Quezon City 1101, Philippines
| | - Felix Haglund
- Department of Oncology-Pathology, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Jan Balko
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham B31 2AP, UK
| | - Vaiyapuri Sumathi
- Department of Musculoskeletal Pathology, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham B31 2AP, UK
| | - Robert Grimer
- The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
| | - Michael Parry
- The Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Birmingham B31 2AP, UK
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Hou Z, Wang C, Li L, Dong L. Retroperitoneal malignant triton tumor in an infant: a case report and literature review. Transl Pediatr 2020; 9:567-572. [PMID: 32953555 PMCID: PMC7475308 DOI: 10.21037/tp.2020.03.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Malignant triton tumor (MTT) is a rare subtype of malignant peripheral nerve sheath tumor (MPNST) with rhabdomyoblastic differentiation. MTTs are solid tumors commonly located in the head, neck, extremities, and trunk. The presence of this tumor in an infant's retroperitoneum is extremely rare, and prompted the authors to report this case with reference to existing literature.
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Affiliation(s)
- Zhibin Hou
- Department of Imaging, Tianjin Children's Hospital, Tianjin 300074, China
| | - Chunxiang Wang
- Department of Imaging, Tianjin Children's Hospital, Tianjin 300074, China
| | - Liang Li
- Department of ENT, Tianjin Children's Hospital, Tianjin 300074, China
| | - Lu Dong
- Department of Imaging, Tianjin Children's Hospital, Tianjin 300074, China
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Zhao A, Ding D, Li X, Wang J. Malignant Triton Tumor in a Child: Case Report and Literature Review. Cancer Manag Res 2019; 11:10759-10766. [PMID: 31920385 PMCID: PMC6935315 DOI: 10.2147/cmar.s221110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/14/2019] [Indexed: 12/02/2022] Open
Abstract
Objective Malignant triton tumor (MTT) is a rare and devastating malignant peripheral nerve-sheath tumor, which shows rapid growth and poor clinical outcomes. Here, we reported a 2-year-old girl who was diagnosed as MTT, an overview of the literature was conducted to discuss the clinical features and optimal treatment strategies of MTT. Methods We conducted an analysis of 42 patients from the PubMed, Medline, Embase and Web of Science databases for relevant articles published between 1938 and 2018. Results A 2-year-old girl died of tumor recurrence. Forty-two eligible cases of MTT in children (birth to 18 years; mean age, 8.3 years), the highest frequency of occurrence was in 12–16 years; and the male-to-female ratio was 1.7:1. Only 33 provided complete treatment details: 11 patients received treatment by surgery alone; 2 received both surgery and chemotherapy; 4 received both surgery and radiation therapy; 14 received surgery, chemotherapy, and radiation therapy; 1 case received chemotherapy and radiation therapy; and only 1 received supportive care. In the 33 cases, the average OS and 5-year OS probability were 23.9 months (range, 0.3–156 months) and 27.5 ± 4.3%. There were significant differences between radiation therapy and patient survival (p<0.05), postoperative chemotherapy/radiation therapy and patient prognosis (p<0.05). Conclusion The clinical and histopathological features and therapeutic options for MTT are discussed in the light of published data. Further studies are needed to improve survival in children with this rare malignant tumor.
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Affiliation(s)
- Ailing Zhao
- Department of Infant Ward, Children's Hospital Affiliated of Zhengzhou University, Zhengzhou, Henan 450018, People's Republic of China.,Department of Infant Ward, Henan Children's Hospital, Zhengzhou, Henan 450018, People's Republic of China.,Department of Infant Ward, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, People's Republic of China
| | - Daling Ding
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, People's Republic of China
| | - Xueqin Li
- Department of Infant Ward, Children's Hospital Affiliated of Zhengzhou University, Zhengzhou, Henan 450018, People's Republic of China.,Department of Infant Ward, Henan Children's Hospital, Zhengzhou, Henan 450018, People's Republic of China.,Department of Infant Ward, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, People's Republic of China
| | - Jiangtao Wang
- Department of Infant Ward, Children's Hospital Affiliated of Zhengzhou University, Zhengzhou, Henan 450018, People's Republic of China.,Department of Infant Ward, Henan Children's Hospital, Zhengzhou, Henan 450018, People's Republic of China.,Department of Infant Ward, Zhengzhou Children's Hospital, Zhengzhou, Henan 450018, People's Republic of China
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Low-grade malignant triton tumor of the neck: a case report and review of the literature. Case Rep Pathol 2014; 2014:674094. [PMID: 25328740 PMCID: PMC4189945 DOI: 10.1155/2014/674094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 08/17/2014] [Indexed: 11/29/2022] Open
Abstract
Rhabdomyoblastic differentiation in a malignant peripheral nerve sheath tumor (MPNST) is termed malignant triton tumor (MTT), a rare neoplasm that poses a diagnostic dilemma in the differential diagnosis of neck masses and portends poor prognosis. We report a sporadic case of MTT of the neck in a 23-year-old female. We present the pathological findings. Immunohistochemistry confirmed the neurogenic origin with S-100 expression and the rhabdomyoblastic differentiation with desmin and vimentin positivity. Radical surgical excision was done. After 4 years there were no signs of recurrence or distant metastasis. The clinical, microscopic, and long-term follow-up of this case are consistent with those of a low-grade malignancy.
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Shetty PK, Baliga SV, Balaiah K. Malignant triton tumor: a rare case. Indian J Surg 2014; 75:362-5. [PMID: 24426617 DOI: 10.1007/s12262-012-0710-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 07/18/2012] [Indexed: 11/28/2022] Open
Abstract
Malignant triton tumor (MTT) is a malignant peripheral nerve sheath tumor (MPNST) with rhabdomyoblastic differentiation. This rare tumor, with fewer than 100 cases reported in the literature, generally affects adult patients with neurofibromatosis 1 (NF-1). We report such a case in a 34-year-old man with NF-1 who presented with a mass over the medial side of the arm. Histopathologically finding of rhabdomyoblasts among malignant Schwann cells in a tumor arising from a peripheral nerve supported by immunostaining with S-100 protein and myogenin confirmed the diagnosis. MTT has a poor prognosis owing to its aggressive biological behavior. The fact that this tumor is extremely rare has prompted us to report this case.
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Affiliation(s)
- Prasad K Shetty
- Department of Pathology and Surgical, Bhagwan Mahaveer Jain Hospital, Bangalore, Karnataka 560052 India
| | - Sameer V Baliga
- Department of Pathology and Surgical, Bhagwan Mahaveer Jain Hospital, Bangalore, Karnataka 560052 India
| | - Kopparthi Balaiah
- Department of Pathology and Surgical, Bhagwan Mahaveer Jain Hospital, Bangalore, Karnataka 560052 India
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9
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Bouvier C, Maues de Paula A, Roche PH, Chagnaud C, Figarella-Branger D. Tumori del sistema nervoso periferico. Neurologia 2013. [DOI: 10.1016/s1634-7072(13)64487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Bouvier C, Maues de Paula A, Roche PH, Chagnaud C, Figarella-Branger D. Tumeurs du système nerveux périphérique. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/s0246-0378(12)58206-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kamran S, Howard S, Shinagare A, Krajewski K, Jagannathan J, Hornick J, Ramaiya N. Malignant peripheral nerve sheath tumors: Prognostic impact of rhabdomyoblastic differentiation (malignant triton tumors), neurofibromatosis 1 status and location. Eur J Surg Oncol 2013; 39:46-52. [DOI: 10.1016/j.ejso.2012.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 08/20/2012] [Accepted: 09/26/2012] [Indexed: 11/29/2022] Open
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12
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Seyhan N, Tosun Z, Avunduk MC, Savacı N. Malignant triton tumor of the oral cavity: a rare occurrence. EUROPEAN JOURNAL OF PLASTIC SURGERY 2011. [DOI: 10.1007/s00238-011-0621-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Tripathy K, Mallik R, Mishra A, Misra D, Rout N, Nayak P, Samantray S, Rath J. A Rare Malignant Triton Tumor. Case Rep Neurol 2010; 2:69-73. [PMID: 20671860 PMCID: PMC2905584 DOI: 10.1159/000315621] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation, malignant triton tumor, has a rare incidence. We report such a case in a 40-year-old male who presented with a mass over the buttock. He was a previously diagnosed case of neurofibroma in the same area. Histomorphology supported by immunostaining with S-100 protein confirmed the diagnosis. Malignant triton tumor has a poor prognosis owing to its aggressive biological behavior. The fact that the presence of this tumor in the buttock region is extremely rare has prompted the authors to report this case.
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Potocka M, Skorek A, Izycka-Swieszewska E. [Malignant Triton tumor of the nose--case report]. Otolaryngol Pol 2009; 63:165-7. [PMID: 19681490 DOI: 10.1016/s0030-6657(09)70100-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Malignant Triton tumor (MTT) is classified as a variant of a malignant peripherial nerve sheath tumor with a focal rhabdomyosarcomatous differentiation. Nearly one third of described MTTs were located at the head and neck region. In following paper we described a case of MTT of the external nose in a 24 year old man. The tumor was totally exised surgically with the broad margins. Histopathological diagnosis of the tumor was made on the surgical specimen, based on immunohistochemical analysis. Radiation therapy as the next step of treatment of choice was performed in presented case.
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