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Tan X, Xiao M, Jiang W, Yue C, Qu L, Zhao G. Paediatric atypical teratoid/rhabdoid tumour of the pineal region mimicking a meningioma: a case report and literature review. Br J Neurosurg 2023; 37:1749-1752. [PMID: 33726577 DOI: 10.1080/02688697.2021.1895971] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/19/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE Atypical teratoid/rhabdoid tumour (AT/RT) is a highly malignant central nervous system tumour of early childhood. According to the latest WHO classification, the diagnosis of AT/RTs needs to be confirmed by the absence of SMARCB1 (INI1) or SMARCA4 (BRG1) protein expression. AT/RT in the pineal region is infrequent and most have not been proven genetically. Here, we report a case of AT/RT in the pineal region, preoperatively misdiagnosed as a meningioma. Immunohistochemistry revealed the absence of INI1 protein expression. METHOD A 29-month-old boy was admitted to the hospital after 14 days of emotional apathy and a 2-day vomiting history. AT/RT was not considered during the initial diagnosis because this tumour is rare in this region and is often accompanied by cystic degeneration and necrosis on imaging. Subsequently, the patient underwent surgery and the tumour was completely excised. RESULT The pathological diagnosis was AT/RT. After discharge, the patient continued chemotherapy in other hospitals but died five months after surgery because of disease progression. CONCLUSION To our knowledge, this is the fifth case of paediatric pineal AT/RT confirmed genetically. Although in children AT/RT in the pineal gland is rare, a differential diagnosis of AT/RT should be considered when new pineal masses appear in children. For this highly malignant disease with poor prognosis, it is very important to detect and recognize the disease as soon as possible, and to adopt surgery plus multiple treatment management.
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Affiliation(s)
- Xuanyu Tan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Mengliang Xiao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Wei Jiang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Cao Yue
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Limei Qu
- Department of Pathology, The First Hospital of Jilin University, Changchun, China
| | - Gang Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Syed H, Teferi N, Hanson A, Challa M, Eschbacher K, Hitchon P. Clinical diagnostic and radiographic features of primary spinal atypical teratoid rhabdoid tumors tumor in a pediatric patient: A case report and review of the literature. J Cent Nerv Syst Dis 2023; 15:11795735231209199. [PMID: 37876767 PMCID: PMC10591496 DOI: 10.1177/11795735231209199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
Atypical teratoid rhabdoid tumors (ATRTs) are rare embryonal tumors comprising 1-2% of all pediatric CNS neoplasms. Spinal ATRTs are even more uncommon, accounting for 2% of all reported ATRT cases. Despite their rarity, ATRTs affect young children disproportionately and are characterized by a high malignant potential due to a heterogeneous cellular composition and inactivating mutations in the SMARCB1 (90%) and SMARCA4 (10%) genes. A 15-month-old female presented with a 2-week history of decreased lower extremity movement and new-onset need for assistance with ambulation. MRI lumbar spine revealed a contrast-enhancing intradural mass at the L3-L4 level with iso-intensity on T1 and T2 sequences. The patient subsequently underwent subtotal tumor resection (∼80%) given concerns for maintaining neurological function. Final pathology was consistent with spinal ATRT, and she later underwent adjuvant chemoradiation therapy per ACNS0333 protocol. She has since remained in remission with age-appropriate developmental milestones over the past 2 years. ATRTs should be considered in the differential diagnosis of intradural spinal lesions, especially in the pediatric patient population. Clinical course, presentation, and diagnosis is often delayed due to the rarity of these tumors, but contrasted craniospinal MRI is key for diagnosis and histopathology with IHC staining showing loss of INI is confirmatory. While gross total resection is the goal, maximal safe tumor resection should be prioritized in order to preserve neurological function. Adjuvant chemoradiation following gross total/subtotal resection has been shown to significantly improve overall survival.
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Affiliation(s)
- Hashim Syed
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Alec Hanson
- University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Meron Challa
- University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Kathryn Eschbacher
- Department of Pathology, University of Iowa Hospital and Clinics, Iowa City, IA, USA
| | - Patrick Hitchon
- Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, USA
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Calandrelli R, Massimi L, Pilato F, Verdolotti T, Ruggiero A, Attinà G, Gessi M, Colosimo C. Atypical Teratoid Rhabdoid Tumor: Proposal of a Diagnostic Pathway Based on Clinical Features and Neuroimaging Findings. Diagnostics (Basel) 2023; 13:diagnostics13030475. [PMID: 36766580 PMCID: PMC9914341 DOI: 10.3390/diagnostics13030475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/17/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
PURPOSE To assess the main imaging and clinical features in adult- and pediatric-onset atypical teratoid rhabdoid tumor (ATRT) in order to build a predefined pathway useful for the diagnosis. METHODS We enrolled 11 ATRT patients (10 children, one adult) and we conducted a literature search on PubMed Central using the key terms "adult" or "pediatric" and "atypical teratoid/rhabdoid tumor". We collected clinical and neuroradiological data reported in previous studies and combined them with those from our case series. A three step process was built to reach diagnosis by identifying the main distinctive clinical and imaging features. RESULTS Clinical evaluation: neurological symptoms were nonspecific. ATRT was more frequent in children under 3 years of age (7 out of 10 children) and infratentorial localization was reported more frequently in children under the age of 24 months. Midline/off-midline localization was influenced by the age. IMAGING FINDINGS Preferential location near the ventricles and liquor spaces and the presence of eccentric cysts were hallmark for ATRT; higher frequency of peripheral cysts was detected in children and in the supratentorial compartment (five out of eight patients with solid-cystic ATRT). Leptomeningeal dissemination at diagnosis was common (5 out of 10 children), while intratumoral hemorrhage, calcifications, and high cellularity were non-specific findings. Histopathological analysis: specific immunohistochemical markers were essential to confirm the diagnosis. CONCLUSION In younger children, a bulky, heterogeneous mass with eccentric cystic components and development near ventricles or cisternal spaces may be suggestive of ATRT. ATRT diagnosis is more challenging in adults and relies exclusively on neuropathological examination.
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Affiliation(s)
- Rosalinda Calandrelli
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
- Correspondence:
| | - Luca Massimi
- Pediatric Neurosurgery, Neurosurgery Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Fabio Pilato
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, 00128 Rome, Italy
| | - Tommaso Verdolotti
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
| | - Antonio Ruggiero
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo F.sco Vito 1, 00168 Rome, Italy
| | - Giorgio Attinà
- UOSD di Oncologia Pediatrica, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cesare Colosimo
- Institute of Radiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 1, 00168 Rome, Italy
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Serrallach BL, Orman G, Boltshauser E, Hackenberg A, Desai NK, Kralik SF, Huisman TAGM. Neuroimaging in cerebellar ataxia in childhood: A review. J Neuroimaging 2022; 32:825-851. [PMID: 35749078 DOI: 10.1111/jon.13017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/27/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022] Open
Abstract
Ataxia is one of the most common pediatric movement disorders and can be caused by a large number of congenital and acquired diseases affecting the cerebellum or the vestibular or sensory system. It is mainly characterized by gait abnormalities, dysmetria, intention tremor, dysdiadochokinesia, dysarthria, and nystagmus. In young children, ataxia may manifest as the inability or refusal to walk. The diagnostic approach begins with a careful clinical history including the temporal evolution of ataxia and the inquiry of additional symptoms, is followed by a meticulous physical examination, and, depending on the results, is complemented by laboratory assays, electroencephalography, nerve conduction velocity, lumbar puncture, toxicology screening, genetic testing, and neuroimaging. Neuroimaging plays a pivotal role in either providing the final diagnosis, narrowing the differential diagnosis, or planning targeted further workup. In this review, we will focus on the most common form of ataxia in childhood, cerebellar ataxia (CA). We will discuss and summarize the neuroimaging findings of either the most common or the most important causes of CA in childhood or present causes of pediatric CA with pathognomonic findings on MRI. The various pediatric CAs will be categorized and presented according to (a) the cause of ataxia (acquired/disruptive vs. inherited/genetic) and (b) the temporal evolution of symptoms (acute/subacute, chronic, progressive, nonprogressive, and recurrent). In addition, several illustrative cases with their key imaging findings will be presented.
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Affiliation(s)
- Bettina L Serrallach
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Eugen Boltshauser
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annette Hackenberg
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nilesh K Desai
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Stephen F Kralik
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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Jana M, Sinha P, Seth R, Kaur K. Clival atypical teratoid/rhabdoid tumor: A diagnostic dilemma. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_145_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang M, Wong SW, Lummus S, Han M, Radmanesh A, Ahmadian SS, Prolo LM, Lai H, Eghbal A, Oztekin O, Cheshier SH, Fisher PG, Ho CY, Vogel H, Vitanza NA, Lober RM, Grant GA, Jaju A, Yeom KW. Radiomic Phenotypes Distinguish Atypical Teratoid/Rhabdoid Tumors from Medulloblastoma. AJNR Am J Neuroradiol 2021; 42:1702-1708. [PMID: 34266866 DOI: 10.3174/ajnr.a7200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Atypical teratoid/rhabdoid tumors and medulloblastomas have similar imaging and histologic features but distinctly different outcomes. We hypothesized that they could be distinguished by MR imaging-based radiomic phenotypes. MATERIALS AND METHODS We retrospectively assembled T2-weighted and gadolinium-enhanced T1-weighted images of 48 posterior fossa atypical teratoid/rhabdoid tumors and 96 match-paired medulloblastomas from 7 institutions. Using a holdout test set, we measured the performance of 6 candidate classifier models using 6 imaging features derived by sparse regression of 900 T2WI and 900 T1WI Imaging Biomarker Standardization Initiative-based radiomics features. RESULTS From the originally extracted 1800 total Imaging Biomarker Standardization Initiative-based features, sparse regression consistently reduced the feature set to 1 from T1WI and 5 from T2WI. Among classifier models, logistic regression performed with the highest AUC of 0.86, with sensitivity, specificity, accuracy, and F1 scores of 0.80, 0.82, 0.81, and 0.85, respectively. The top 3 important Imaging Biomarker Standardization Initiative features, by decreasing order of relative contribution, included voxel intensity at the 90th percentile, inverse difference moment normalized, and kurtosis-all from T2WI. CONCLUSIONS Six quantitative signatures of image intensity, texture, and morphology distinguish atypical teratoid/rhabdoid tumors from medulloblastomas with high prediction performance across different machine learning strategies. Use of this technique for preoperative diagnosis of atypical teratoid/rhabdoid tumors could significantly inform therapeutic strategies and patient care discussions.
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Affiliation(s)
- M Zhang
- From the Departments of Neurosurgery (M.Z.)
| | - S W Wong
- Department of Statistics (S.W.W.), Stanford University, Stanford, California
| | - S Lummus
- Department of Physiology and Nutrition (S.L.), University of Colorado, Colorado Springs, Colorado
| | - M Han
- Department of Pediatrics (M.H.), Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - A Radmanesh
- Department of Radiology (A.R.), New York University Grossman School of Medicine, New York, New York
| | - S S Ahmadian
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - L M Prolo
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - H Lai
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - A Eghbal
- Department of Radiology (H.L., A.E.), Children's Hospital of Orange County, Orange, California and University of California, Irvine, Irvine, California
| | - O Oztekin
- Department of Neuroradiology (O.O.), Cigli Education and Research Hospital, Bakircay University, Izmir, Turkey.,Department of Neuroradiology (O.O.), Tepecik Education and Research Hospital, Health Science University, Izmir, Turkey
| | - S H Cheshier
- Division of Pediatric Neurosurgery (S.H.C.), Department of Neurosurgery, Huntsman Cancer Institute, Intermountain Healthcare Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - C Y Ho
- Departments of Clinical Radiology & Imaging Sciences (C.Y.H.), Riley Children's Hospital, Indiana University, Indianapolis, Indiana
| | - H Vogel
- Pathology (S.S.A., H.V.), Stanford Medical Center, Stanford University, Stanford, California
| | - N A Vitanza
- Division of Pediatric Hematology/Oncology (N.A.V.), Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - R M Lober
- Division of Neurosurgery (R.M.L.), Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, Ohio
| | - G A Grant
- Departments of Neurosurgery (L.M.P., G.A.G.)
| | - A Jaju
- Department of Medical Imaging (A.J.), Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - K W Yeom
- Radiology (K.W.Y.), Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
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Esa MMM, Mashaly EM, El-Sawaf YF, Dawoud MM. Diagnostic accuracy of apparent diffusion coefficient ratio in distinguishing common pediatric CNS posterior fossa tumors. Egypt J Radiol Nucl Med 2020. [DOI: 10.1186/s43055-020-00194-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Abstract
Background
Pilocytic astrocytoma, medulloblastoma, and ependymoma are the most common pediatric CNS tumors seen at posterior cranial fossa and final diagnosis obtained by histopathology after surgical excision. Routine MRI study gives an idea about site and extension of the tumors but provide a little information about type and grade of tumors. ADC ratio had high sensitivity and specificity in differentiation between these tumors as regard type and grade according to tumor cellularity.
Patients and methods
Prospective study conducted on thirty pediatric patients (11 males and 19 females) with CNS posterior fossa masses, their ages ranged from 2 to 17 years (mean age of 8.7 years), conventional MRI, DWI, ADC value, and ADC ratio were done for all patients.
Results
ADC values were significantly different between pilocytic astrocytomas (1.43 ± 0.28 × 10−3) and medulloblastomas (0.71 ± 0. 21 × 10−3) with a P value < 0.001, also there was a significant difference when comparing medulloblastomas (0.71 ± 0.21 × 10−3) with ependymomas (1.04 × 10−3 ± 0.21) with a P value < 0.001. ADC ratio at a cutoff > 1.7 showed significant good power of discrimination of astrocytoma (AUC = 0.85) from ependymoma with 87.5% sensitivity and 93.3% specificity. Similarly, at cutoff ≤ 1.6-> 1.2 was a significant good predictor of ependymoma (AUC = 0.85) with 87.8% sensitivity and 99.5% specificity. While, ADC ratio ≤ 1.2 was significant excellent discriminator of medulloblastoma (AUC = 0.99) with 100% sensitivity and 90% specificity.
Conclusion
ADC ratio is a simple way used in distinguishing juvenile pilocytic astrocytoma, ependymoma, and medulloblastoma, which are the most frequent pediatric posterior fossa tumors. Cutoff ADC ratio of more than 1.7 characteristic of JPA with 87.5% sensitivity and 93.3% specificity, ADC ratio less than 1.1 characteristic of medulloblastoma with 100% sensitivity and 90% specificity. ADC ratios more than 1.1 and less than 1.7 characteristic of ependymoma with 87.8% sensitivity and 99.5% specificity. We recommended ADC ratio as a routine study in evaluation of pediatric CNS posterior fossa tumors.
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Abstract
Significant advances in the field of neonatal imaging has resulted in the generation of large complex data sets of relevant information for routine daily clinical practice, and basic and translational research. The evaluation of this data is a complex task for the neonatal imager who must distinguish normal and incidental findings from clinically significant abnormalities which are often adjunctive data points applicable to clinical evaluation and treatment. This review provides an overview of the imaging manifestations of disease processes commonly encountered in the neonatal brain. Since MRI is currently the highest yield technique for the diagnosis and characterization of the normal and abnormal brain, it is therefore the focus of the majority of this review. When applicable, discussion of some of the pertinent known pathophysiology and neuropathological aspects of disease processes are reviewed.
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Kramer DE, Kerolus MG, Nunna RS, Tan LA, Jhaveri M, Nag S, Munoz LF. Atypical Teratoid/Rhabdoid Tumor of the Conus Medullaris. Pediatr Neurosurg 2020; 55:215-221. [PMID: 32882703 DOI: 10.1159/000509165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Atypical teratoid/rhabdoid tumor (AT/RT) is a rare tumor of the central nervous system, especially when involving the spinal column or spinal cord. CASE PRESENTATION We present a case of a 5-year-old girl with progressive bilateral lower extremity pain found to have a discrete nodular lesion of the conus with mild heterogeneous enhancement. Surgical decompression and resection demonstrated a pathologic tumor consistent with AT/RT with loss of INI1 protein on immunohistochemistry. DISCUSSION AND CONCLUSION AT/RT lesions of the conus medullaris are exceedingly rare and associated with extensive disease. We report a rare case of AT/RT with selective involvement of the conus medullaris, as well as describe the surgical, radiographic, and pathologic findings of this tumor.
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Affiliation(s)
- Dallas E Kramer
- Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Mena G Kerolus
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA,
| | - Ravi S Nunna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Lee A Tan
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Miral Jhaveri
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sukriti Nag
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lorenzo F Munoz
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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Xu X, Li J, Zheng Y, Li F. Primary atypical teratoid/rhabdoid tumor of spinal canal in a child: Case report and the literature review. Interdisciplinary Neurosurgery 2019; 18:100480. [DOI: 10.1016/j.inat.2019.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nowak J, Nemes K, Hohm A, Vandergrift LA, Hasselblatt M, Johann PD, Kool M, Frühwald MC, Warmuth-Metz M. Magnetic resonance imaging surrogates of molecular subgroups in atypical teratoid/rhabdoid tumor. Neuro Oncol 2019; 20:1672-1679. [PMID: 30010851 DOI: 10.1093/neuonc/noy111] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Recently, 3 molecular subgroups of atypical teratoid/rhabdoid tumor (ATRT) were identified, but little is known of their clinical and magnetic resonance imaging (MRI) characteristics. Methods A total of 43 patients with known molecular subgroup status (ATRT-sonic hedgehog [SHH], n = 17; ATRT-tyrosine [TYR], n = 16; ATRT-myelocytomatosis oncogene [MYC], n = 10) were retrieved from the EU-RHAB Registry and analyzed for clinical and MRI features. Results On MRI review, differences in preferential tumor location were confirmed, with ATRT-TYR being predominantly located infratentorially (P < 0.05). Peritumoral edema was more pronounced in ATRT-MYC compared with ATRT-SHH (P < 0.05) and ATRT-TYR (P < 0.05). Conversely, peripheral tumor cysts were found more frequently in ATRT-SHH (71%) and ATRT-TYR (94%) compared with ATRT-MYC (40%, P < 0.05). Contrast enhancement was absent in 29% of ATRT-SHH (0% of ATRT-TYR; 10% of ATRT-MYC; P < 0.05), and there was a trend toward strong contrast enhancement in ATRT-TYR and ATRT-MYC. We found the characteristic (bandlike) enhancement in 28% of ATRT as well as restricted diffusion in the majority of tumors. A midline/off-midline location in the posterior fossa was also not subgroup specific. Visible meningeal spread (M2) at diagnosis was rare throughout all subgroups. Conclusion These exploratory findings suggest that MRI features vary across the 3 molecular subgroups of ATRT. Within future prospective trials, MRI may aid diagnosis and treatment stratification.
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Affiliation(s)
- Johannes Nowak
- Reference Center for Neuroradiology, Institute for Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany.,Institute for Diagnostic and Interventional Radiology, University Hospital of Würzburg, Würzburg, Germany
| | - Karolina Nemes
- Swabian Childrens' Cancer Center, Children's Hospital Augsburg and European-Rhabdoid (EU-RHAB) Registry, Augsburg, Germany
| | - Annika Hohm
- Reference Center for Neuroradiology, Institute for Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany
| | - Lindsey A Vandergrift
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Pascal D Johann
- Hopp-Children's Cancer Center at the National Center for Tumor Diseases Heidelberg, Heidelberg, Germany.,Division of Pediatric Neuro-Oncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.,Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcel Kool
- Hopp-Children's Cancer Center at the National Center for Tumor Diseases Heidelberg, Heidelberg, Germany.,Division of Pediatric Neuro-Oncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Michael C Frühwald
- Swabian Childrens' Cancer Center, Children's Hospital Augsburg and European-Rhabdoid (EU-RHAB) Registry, Augsburg, Germany.,Department of Pediatric Hematology and Oncology, University Children's Hospital Münster, Münster, Germany
| | - Monika Warmuth-Metz
- Reference Center for Neuroradiology, Institute for Diagnostic and Interventional Neuroradiology, University Hospital of Würzburg, Würzburg, Germany
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Li D, Heiferman DM, Syed HR, Santos JG, Bowman RM, DiPatri AJ, Tomita T, Wadhwani NR, Alden TD. Pediatric primary spinal atypical teratoid rhabdoid tumor: a case series and review of the literature. J Neurosurg Pediatr 2019; 24:267-283. [PMID: 31299639 DOI: 10.3171/2019.4.peds19113] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/29/2019] [Indexed: 12/20/2022]
Abstract
Atypical teratoid rhabdoid tumors (ATRTs) are rare malignant central nervous system tumors, commonly occurring before 3 years of age. Median overall survival (OS) of patients with these tumors is about 1 year, despite aggressive multimodal therapy. Pediatric primary spinal ATRTs are even more rare, with fewer than 50 cases reported. The authors present a series of four patients who were treated at Ann and Robert H. Lurie Children's Hospital of Chicago in the period from 1996 to 2017.These patients, with ages 2-11 years, presented with pain and a decline in motor functions. They were found to have lesions in the lumbar, thoracic, and/or cervical spine. One patient's tumor was intramedullary with exophytic components, while another patient's tumor had both intra- and extradural components. All patients underwent resection followed by chemotherapy (systemic and intrathecal). Two patients had fractionated radiation therapy and one had an autologous stem cell transplant. Three patients are known to be deceased (OS 8.5-45 months). The fourth patient was in remission 19 years after her initial diagnosis. To the authors' knowledge, this is the largest series of pediatric primary spinal ATRTs documented at a single institution. These cases illustrate a variety of presentations of spinal ATRT and add to the body of literature on this aggressive pathology.A systematic MEDLINE search was also conducted using the keywords "atypical teratoid rhabdoid tumor," "pediatric spinal rhabdoid tumor," and "malignant rhabdoid tumor spine." Reports were included for patients younger than 21 years, without evidence of intracranial or systemic disease at the time of diagnosis. Clinical characteristics and outcomes of the four institutional cases were compared to those in the literature. This review yielded an additional 48 cases of primary pediatric spinal ATRTs reported in the English-language literature. Patients (ages 2 months to 19 years) presented with symptoms of pain, regression of motor function, and spinal cord compression. The majority of tumors were intradural (14 extramedullary, 8 intramedullary, 1 both). Eleven cases in the literature described tumors limited to extradural structures, while 10 tumors involved the intra- and extradural spine. Four reports did not specify tumor location. Although rare, spinal ATRT should be considered in the differential diagnosis of pediatric patients presenting with a new spinal mass.
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Affiliation(s)
- Daphne Li
- 1Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Daniel M Heiferman
- 1Department of Neurological Surgery, Loyola University Stritch School of Medicine, Maywood, Illinois
| | - Hasan R Syed
- 2Department of Neurological Surgery, Division of Pediatric Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - João Gustavo Santos
- 3Department of Neurological Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Robin M Bowman
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
| | - Arthur J DiPatri
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
| | - Tadanori Tomita
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
| | - Nitin R Wadhwani
- 6Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tord D Alden
- 4Department of Surgery, Division of Pediatric Neurosurgery, Ann and Robert H. Lurie Children's Hospital of Chicago; and
- Departments of5Neurological Surgery and
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Abstract
Embryonal tumors of the central nervous system (CNS) are highly malignant undifferentiated or poorly differentiated tumors of neuroepithelial origin and have been defined as a category in the World Health Organization (WHO) classification since the first edition of the "Blue Book" in 1979. This category has evolved over time to reflect our ever-improving understanding of tumor biology and behavior. With the most recent update in 2016, many previous histologic diagnoses incorporate molecular parameters for the first time (genetically defined entities). While medulloblastoma and atypical teratoid/rhabdoid tumor are familiar carryovers from the 2007 CNS WHO classification, there are major changes to the embryonal tumor category: for example, elimination of the term CNS primitive neuroectodermal tumor and addition of a new genetically defined entity, embryonal tumor with multilayered rosettes, C19MC-altered. The purpose of this article is to discuss both the radiologic-pathologic features of CNS embryonal tumors and the new molecularly defined types/subtypes that will become the standard classification/terminology for future diagnoses and tumor research.
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Affiliation(s)
- Robert Y Shih
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.)
| | - Kelly K Koeller
- From the Department of Neuroradiology, American Institute for Radiologic Pathology, Silver Spring, Md (R.Y.S., K.K.K.); Uniformed Services University of the Health Sciences, Bethesda, Md (R.Y.S.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (R.Y.S.); and Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (K.K.K.)
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Mata-Mbemba D, Donnellan J, Krishnan P, Shroff M, Muthusami P. Imaging Features of Common Pediatric Intracranial Tumours: A Primer for the Radiology Trainee. Can Assoc Radiol J 2018; 69:105-117. [DOI: 10.1016/j.carj.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Daddy Mata-Mbemba
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Donnellan
- Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pradeep Krishnan
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Manohar Shroff
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
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Shiflett JM, Herrington BL, Joyner DA, Saad AG. Atypical Teratoid Rhabdoid Tumor of the Cauda Equina in a Child: Report of a Very Unusual Case. Appl Immunohistochem Mol Morphol 2020; 28:e58-62. [PMID: 29346182 DOI: 10.1097/PAI.0000000000000620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atypical teratoid/rhabdoid tumors (AT/RT) are highly aggressive malignant primitive neoplasms that commonly occur in children younger than 2 years of age. The prognosis is generally dismal with a median survival time of <1 year. The majority of AT/RT occur in the posterior fossa and less frequently the supratentorium. Primary pediatric spinal AT/RT are exceedingly rare and only 15 cases have been reported to date. Here we report a very unusual case of primary spinal AT/RT extensively involving the spinal cord from T11 down to the cauda equina. In this patient, the tumor was highly aggressive and resulted in extensive dissemination into the nerve roots and paraspinal soft tissue rapidly resulting in the patient's death 1 month after diagnosis. to the best of our knowledge, this degree of involvement of the spine by a primary AT/RT has not been described before.
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16
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Nakata S, Nobusawa S, Hirose T, Ito S, Inoshita N, Ichi S, Amatya VJ, Takeshima Y, Sugiyama K, Sonoda Y, Haga H, Hirato J, Nakazato Y, Yokoo H. Sellar Atypical Teratoid/Rhabdoid Tumor (AT/RT): A Clinicopathologically and Genetically Distinct Variant of AT/RT. Am J Surg Pathol 2017; 41:932-40. [DOI: 10.1097/pas.0000000000000845] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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17
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Abstract
Brain tumors can develop in the prenatal and neonatal time periods. Neuroimaging studies are crucial for the early detection of prenatal and neonatal brain tumors. Imaging allows for characterization of morphology, as well as the detection of hydrocephalus, local invasion, and distant spread. The imaging features of the more common neonatal brain tumors, including teratomas, choroid plexus tumors, ATRTs, and neoplasm mimics are described.
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Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a highly malignant embryonal central nervous system tumor commonly affecting children <3 years of age. It roughly constitutes 1%-2% of all pediatric central nervous system tumors. Recent data show that it is the most common malignant central nervous system tumor in children <6 months of age. Management of this aggressive tumor is associated with a myriad of diagnostic and therapeutic challenges. On the basis of radiology and histopathology alone, distinction of AT/RT from medulloblastoma or primitive neuroectodermal tumor is difficult, and hence this tumor has been commonly misdiagnosed as primitive neuroectodermal tumor for decades. Presence of a bulky heterogeneous solid-cystic mass with readily visible calcification and intratumor hemorrhage, occurring off-midline in children <3 years of age, should alert the radiologist toward the possibility of AT/RT. Presence of rhabdoid cells on histopathology and polyphenotypic immunopositivity for epithelial, mesenchymal, and neuroectodermal markers along with loss of expression of SMARCB1/INI1 or SMARCA4/BRG1 help in establishing a diagnosis of AT/RT. The optimal management comprises maximal safe resection followed by radiation therapy and multiagent intensive systemic chemotherapy. Gross total excision is difficult to achieve in view of the large tumor size and location and young age at presentation. Leptomeningeal spread is noted in 15%-30% of patients, and hence craniospinal irradiation followed by boost to tumor bed is considered standard in children older than 3 years. However, in younger children, craniospinal irradiation may lead to long-term neurocognitive and neuroendocrine sequel, and hence focal radiation therapy may be a pragmatic approach. In this age group, high-dose chemotherapy with autologous stem cell rescue may also be considered to defer radiation therapy, but this approach is also associated with significant treatment-related morbidity and mortality. Novel small molecule inhibitors hold promise in preclinical studies and should be considered in patients with relapsed or refractory tumor.
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Affiliation(s)
| | | | - Aanchal Kakkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Mankotia DS, Tandon V, Sharma BS, Rajeshwari M, Sharma MC. A case of primary spinal atypical teratoid/rhabdoid tumor in a 5-year-old child. J Pediatr Neurosci 2016; 11:121-4. [PMID: 27606020 PMCID: PMC4991152 DOI: 10.4103/1817-1745.187634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a rare central nervous system neoplasm affecting children, and isolated primary spinal involvement is extremely rare. Authors describe a case of spinal AT/RT in a 5-year-old male child presenting with rapidly progressing quadriparesis diagnosed and managed surgically and medically. Biopsy revealed large, rhabdoid cells with prominent nucleoli in nest and immunohistochemistry further showed loss of integrase integrator 1 expression considered to be gold standard for diagnosis. AT/RT has extremely poor prognosis with median survival being 6 months.
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Affiliation(s)
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Madhu Rajeshwari
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - Mehar Chand Sharma
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
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20
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Oh CC, Orr BA, Bernardi B, Garré ML, Rossi A, Figà-Talamanca L, Robinson GW, Patay Z. Atypical teratoid/rhabdoid tumor (ATRT) arising from the 3rd cranial nerve in infants: a clinical-radiological entity? J Neurooncol 2015; 124:175-83. [PMID: 26148473 DOI: 10.1007/s11060-015-1787-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
Atypical teratoid/rhabdoid tumor (ATRT) is a rare embryonal tumor of the central nervous system with preponderance in very young children, the majority of whom are younger than 3 years of age at diagnosis. Historically, outcomes of this aggressive disease, even with extensive multimodal therapy, have been dismal. Recent improvements have come from therapies directed exclusively towards ATRT, but misdiagnosis or delays in the correct diagnosis lead to significantly worse survival rates. ATRTs most commonly occur supratentorially but have been described in virtually all central nervous system locations, including the cerebellopontine angle cistern, meninges, and spinal canal, and extradural locations. ATRTs originating from cranial nerves are rare. Here, we describe three cases of solitary ATRT arising from the 3rd cranial nerve (CN III) or close to its origin in the midbrain, all of which presented in patients within 6 months of birth, with isolated unilateral oculomotor nerve palsy and strikingly similar magnetic resonance imaging (MRI) features. These MRI features include IV contrast enhancement, relative T2 hyposignal, and restricted water diffusion on apparent diffusion coefficient images, findings which are consistent with angiogenesis and high cellularity, and hence, suggestive of malignancy. We conclude that ATRT should be placed high on the differential diagnosis list when encountering a young infant presenting with isolated, unilateral 3rd nerve palsy and a small, solitary tumor arising from CN III that demonstrates malignant conventional and diffusion-weighted imaging features on MRI.
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Taschner CA, Erny D, Shah MJ, Eckenweiler M, Urbach H, Lutz K, Prinz M. Freiburg Neuropathology Case Conference: An Infant with a Supratentorial Mass Lesion. Clin Neuroradiol 2015; 25:211-7. [PMID: 25967602 DOI: 10.1007/s00062-015-0400-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- C A Taschner
- Department of Neuroradiology, Medical Centre-University of Freiburg, Freiburg, Germany,
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22
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Jin B, Feng XY. MRI features of atypical teratoid/rhabdoid tumors in children. Pediatr Radiol 2013; 43:1001-8. [PMID: 23467756 DOI: 10.1007/s00247-013-2646-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumors (AT/RTs) are rare, highly malignant tumors of the central nervous system, usually occurring in young children. OBJECTIVE To investigate the MRI features of AT/RT, with special emphasis on diffusion-weighted imaging (DWI) and MR spectroscopy (MRS). MATERIALS AND METHODS MRI findings of 11 children with AT/RT were reviewed retrospectively, including DWI in 9 AT/RT children and MRS in 6 children. RESULTS The neoplasms were infratentorial in 4 children and supratentorial in 5 children, both infra- and supratentorial in 1 child and multifocal in 1 child. AT/RT produced heterogeneous signal intensity from peripheral cysts in 7/11 (63%) and hemorrhage in 7/11 (63%). All lesions showed contrast enhancement of varying degrees. Seven (63%) had peritumoral edema. Nine (82%) were hyperintense on DWI with a mean ± SD ADC of 0.60 ± 0.13 × 10(-3) mm(2) s(-1). Six lesions (55%) exhibited elevated levels of choline and decreased NAA, and three had lipid peaks. CONCLUSIONS A childhood intracranial tumor with off-midline location, peripheral cystic components, hemorrhage, low ADC, and lipid peaks on MRS suggests AT/RT to be considered a differential diagnosis.
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Mohamed FF, Azeem Ismail AA, Hasan DI, Essa WE. The role of apparent diffusion coefficient (ADC) value in the differentiation between the most common pediatric posterior fossa tumors. The Egyptian Journal of Radiology and Nuclear Medicine 2013. [DOI: 10.1016/j.ejrnm.2012.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Warmuth-Metz M, Bison B, Gerber NU, Pietsch T, Hasselblatt M, Frühwald MC. Bone involvement in atypical teratoid/rhabdoid tumors of the CNS. AJNR Am J Neuroradiol 2013; 34:2039-42. [PMID: 23681355 DOI: 10.3174/ajnr.a3554] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
SUMMARY Destruction of the bony structures of the skull is rare in primary tumors of the CNS. In low-grade gliomas, modeling of the skull is caused by slow growth and chronic pressure. Bony destruction is exceptional even in highly malignant gliomas. Atypical teratoid/rhabdoid tumors of the CNS are highly malignant neoplasms diagnosed with an increasing frequency, mainly in young children. On imaging, these tumors exhibit distinct though not specific morphologic features including peripheral cysts, bleeding residues, and a distinct bandlike, wavy pattern of enhancement. A combination of these single characteristics together with a predilection for young age is suggestive of an atypical teratoid/rhabdoid tumor. We present 5 children with an atypical teratoid/rhabdoid tumor affecting the adjacent bone. These 5 patients were collected in our imaging data base for childhood atypical teratoid/rhabdoid tumor consisting of 91 children at the time of this evaluation and thus representing 6.6%. The mean age of children with bone involvement (4.8 years) was above the average age (2 years) of all children in the data base. We add this rare feature to the list of typical features in MR imaging and CT morphology of atypical teratoid/rhabdoid tumor.
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Affiliation(s)
- M Warmuth-Metz
- National Reference Center for Neuroradiology, Department of Neuroradiology, University Hospital of Wurzburg, Wurzburg, Germany
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Au Yong KJ, Jaremko JL, Jans L, Bhargava R, Coleman LT, Mehta V, Ditchfield MR. How specific is the MRI appearance of supratentorial atypical teratoid rhabdoid tumors? Pediatr Radiol 2013; 43:347-54. [PMID: 23143401 DOI: 10.1007/s00247-012-2530-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/21/2012] [Accepted: 08/23/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supratentorial atypical teratoid rhabdoid tumor (ATRT) in many cases has a distinctive appearance on post-gadolinium MRI. OBJECTIVE We sought to determine whether this is a unique appearance allowing ATRT to be distinguished accurately from other types of pediatric supratentorial tumors. MATERIALS AND METHODS Retrospective review of all available preoperative MRI of pediatric supratentorial tumors at two tertiary children's hospitals, and systematic literature review of case series and reports describing the MRI imaging appearances of supratentorial ATRT. RESULTS We had 61 supratentorial tumors, including 32 gliomas, 6 ATRT, 8 ependymomas, 6 gangliogliomas, 2 pilomyxoid astrocytomas, 3 primitive neuro-ectodermal tumors, 2 choroid plexus papillomas, and 2 meningiomas. ATRT presented in significantly younger patients than astrocytomas (mean age 2.6 years vs. 9.9 years, P < 0.05). The visual pattern of a thick, wavy (irregular) heterogeneously enhancing wall around a cystic center was seen in 5/6 (83%) ATRTs and only 3/55 (5.4%) other tumors (P < 0.0001), for specificity of 95%, sensitivity of 83%, positive predictive value of 63% and a negative predictive value of 95%. CONCLUSION A supratentorial tumor with a thick, wavy (irregular) heterogeneously enhancing wall surrounding a central cystic region is suggestive of ATRT in the appropriate clinical setting, especially in a child of preschool age.
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Affiliation(s)
- Kong Jung Au Yong
- Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, 8440-112 Street NW, Edmonton, Canada, T6G 2B7,
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Imagama S, Wakao N, Ando K, Hirano K, Tauchi R, Muramoto A, Matsui H, Matsumoto T, Ukai J, Kobayashi K, Shinjo R, Nakashima H, Maruyama K, Matsuyama Y, Ishiguro N. Treatment for primary spinal atypical teratoid/rhabdoid tumor. J Orthop Sci 2012; 17:822-7. [PMID: 21720800 DOI: 10.1007/s00776-011-0122-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 06/10/2011] [Indexed: 11/24/2022]
Affiliation(s)
- Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi 466-8550, Japan.
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Poretti A, Meoded A, Huisman TAGM. Neuroimaging of pediatric posterior fossa tumors including review of the literature. J Magn Reson Imaging 2011; 35:32-47. [PMID: 21989968 DOI: 10.1002/jmri.22722] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Accepted: 06/23/2011] [Indexed: 01/06/2023] Open
Abstract
Conventional, anatomical MRI is an essential tool for diagnosis and evaluation of location, quality, and extent of posterior fossa tumors, but offers limited information regarding tumor grade and type. Advanced MRI techniques such as diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) may improve the specific diagnosis of brain tumors in the posterior fossa in children. In this review the conventional neuroimaging findings, as well as the DWI, and DTI characteristics of common pediatric posterior fossa tumors are discussed and summarized.
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Affiliation(s)
- Andrea Poretti
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Pai Panandiker AS, Merchant TE, Beltran C, Wu S, Sharma S, Boop FA, Jenkins JJ, Helton KJ, Wright KD, Broniscer A, Kun LE, Gajjar A. Sequencing of local therapy affects the pattern of treatment failure and survival in children with atypical teratoid rhabdoid tumors of the central nervous system. Int J Radiat Oncol Biol Phys 2011; 82:1756-63. [PMID: 21601374 DOI: 10.1016/j.ijrobp.2011.02.059] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/22/2011] [Accepted: 02/25/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the pattern of treatment failure associated with current therapeutic paradigms for childhood atypical teratoid rhabdoid tumors (AT/RT). METHODS AND MATERIALS Pediatric patients with AT/RT of the central nervous system treated at our institution between 1987 and 2007 were retrospectively evaluated. Overall survival (OS), progression-free survival, and cumulative incidence of local failure were correlated with age, sex, tumor location, extent of disease, and extent of surgical resection. Radiotherapy (RT) sequencing, chemotherapy, dose, timing, and volume administered after resection were also evaluated. RESULTS Thirty-one patients at a median age of 2.3 years at diagnosis (range, 0.45-16.87 years) were enrolled into protocols that included risk- and age-stratified RT. Craniospinal irradiation with focal tumor bed boost (median dose, 54 Gy) was administered to 18 patients. Gross total resection was achieved in 16. Ten patients presented with metastases at diagnosis. RT was delayed more than 3 months in 20 patients and between 1 and 3 months in 4; 7 patients received immediate postoperative irradiation preceding high-dose alkylator-based chemotherapy. At a median follow-up of 48 months, the cumulative incidence of local treatment failure was 37.5% ± 9%; progression-free survival was 33.2% ± 10%; and OS was 53.5% ± 10%. Children receiving delayed RT (≥1 month postoperatively) were more likely to experience local failure (hazard ratio [HR] 1.23, p = 0.007); the development of distant metastases before RT increased the risk of progression (HR 3.49, p = 0.006); and any evidence of disease progressionbefore RT decreased OS (HR 20.78, p = 0.004). Disease progression occurred in 52% (11/21) of children with initially localized tumors who underwent gross total resection, and the progression rate increased proportionally with increasing delay from surgery to RT. CONCLUSIONS Delayed RT is associated with a higher rate of local and metastatic disease progression in children with AT/RT. Current treatment regimens for pediatric patients with AT/RT are distinctly age stratified; novel protocols investigating RT volumes and sequencing are needed.
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Mohapatra I, Santosh V, Chickabasaviah YT, Mahadevan A, Tandon A, Ghosh A, Chidambaram B, Sampath S, Bhagavatula ID, Chandramouli BA, Kolluri SVR, Shankar SK. Histological and immunohistochemical characterization of AT/RT: a report of 15 cases from India. Neuropathology 2009; 30:251-9. [PMID: 19925561 DOI: 10.1111/j.1440-1789.2009.01075.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Atypical teratoid rhabdoid tumor (AT/RT) is a highly malignant embryonal CNS tumor, generally unresponsive to any form of therapy, uniformly fatal within 1 year. We report 15 cases of AT/RT diagnosed at our center over a period of 5 years (2003-08). Tumors were located in different sites of the neuraxis, posterior fossa being the most common (n = 10) followed by cerebral lobes (n = 3). There was one each at the supra sellar and cervical spinal regions, respectively. Radiologically most of the tumors were heterodense and enhancing heterogeneously. The tumors exhibited diverse histological profile that included rhabdoid and PNET areas in all cases, mesenchymal and epithelial areas in 73.3% and 53.3% cases, respectively. Necrosis was evident in all cases and one showed calcification. Tumor cells displayed a polyphenotypic immunoprofile. All cases were consistently positive for vimentin and epithelial membrane antigen and were negative for desmin. Variable positivity was seen for other markers. The number of cases positive for these were: CK (53%), SMA (60%), synaptophysin (66%), NFP (33.3%) and GFAP (85%). CK staining was prominent in epithelial areas, while PNET cells labeled prominently with synaptophysin. There was lack of INI1 expression in all cases. Follow-up was available in 46.6% of cases which revealed a uniform poor prognosis.
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Affiliation(s)
- Ishani Mohapatra
- Department of Neuropathology, National Institutes of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Warmuth-Metz M, Bison B, Dannemann-Stern E, Kortmann R, Rutkowski S, Pietsch T. CT and MR imaging in atypical teratoid/rhabdoid tumors of the central nervous system. Neuroradiology 2008; 50:447-52. [PMID: 18345534 DOI: 10.1007/s00234-008-0369-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Accepted: 02/11/2008] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Atypical teratoid/rhabdoid tumors (ATRT) are rare aggressive neoplasms of the CNS affecting predominantly very young children. METHODS We retrospectively reviewed the imaging findings of 9 CT and 32 MR examinations of the brain and spine of 33 children. RESULTS Of the 33 tumors, 11 were located in the infratentorial compartment, 16 in the supratentorial compartment, 5 in both cranial compartments, and 1 in the lower thoracic spinal cord. The mean age of the children with infratentorial or infra- and supratentorial tumors was significantly lower than the mean age of the children with purely supratentorial tumors. Heterogeneity on imaging, large size and high tumor stages are striking features reflecting the aggressive nature of this histopathological entity. Although not present in the majority of children, a distinct and unusual pattern of a wavy band-like enhancement surrounding a central hypointensity was present in 12 of 32 children (38%) in whom contrast medium was used. CONCLUSION To the best of our knowledge this is the largest number of imaging examinations of ATRTs so far reported. A rather unusual pattern of contrast enhancement may be typical of ATRTs.
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Affiliation(s)
- Monika Warmuth-Metz
- Reference Centre for Neuroradiology of the German Society for Pediatric Hematology and Oncology (GPOH), Department of Neuroradiology, University of Würzburg, Würzburg, Germany.
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Seno T, Kawaguchi T, Yamahara T, Sakurai Y, Oishi T, Inagaki T, Yamanouchi Y, Asai A, Kawamoto K. An immunohistochemical and electron microscopic study of atypical teratoid/rhabdoid tumor. Brain Tumor Pathol 2008; 25:79-83. [DOI: 10.1007/s10014-008-0236-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 06/12/2008] [Indexed: 11/29/2022]
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Chiou SH, Kao CL, Chen YW, Chien CS, Hung SC, Lo JF, Chen YJ, Ku HH, Hsu MT, Wong TT. Identification of CD133-positive radioresistant cells in atypical teratoid/rhabdoid tumor. PLoS One 2008; 3:e2090. [PMID: 18509505 PMCID: PMC2396792 DOI: 10.1371/journal.pone.0002090] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 03/09/2008] [Indexed: 12/11/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is an extremely malignant neoplasm in the central nervous system (CNS) which occurs in infancy and childhood. Recent studies suggested that CD133 could be considered a marker for brain cancer stem-like cells (CSCs). However, the role of CD133 in AT/RT has never been investigated. Herein we report the isolation of CD133-positive cells (CD133+), found to have the potential to differentiate into three germ layer tissues, from tissues of nine AT/RT patients. The migration/invasion/malignancy and radioresistant capabilities of CD133+ were significantly augmented when compared to CD133−. The clinical data showed that the amount of CD133+ in AT/RTs correlated positively with the degree of resistance to radiation therapy. Using cDNA microarray analysis, the genotoxic–response profiles of CD133+ and CD133− irradiated with 10 Gy ionizing radiation (IR) were analyzed 0.5, 2, 6, 12 and 24 h post-IR. We then validated these microarray data and showed increased phosphorylation after IR of p-ATM, p-RAD17, and p-CHX2 as well as increased expression of BCL-2 protein in CD133+ compared to CD133−. Furthermore, we found that CD133+ can effectively resist IR with cisplatin- and/or TRAIL-induced apoptosis. Immunohistochemical analysis confirmed the up-regulated expression of p-ATM and BCL-2 proteins in IR-treated CD133+ xenotransgrafts in SCID mice but not in IR-treated CD133−. Importantly, the effect of IR in CD133+ transplanted mice can be significantly improved by a combination of BCL-2 siRNA with debromohymenialdisine, an inhibitor of checkpoint kinases. In sum, this is the first report indicating that CD133+ AT/RT cells demonstrate the characteristics of CSCs. The IR-resistant and anti-apoptotic properties in CD133+ may reflect the clinical refractory malignancy of AT/RTs and thus the activated p-ATM pathway and BCL-2 expression in CD133+ could be possible targets to improve future treatment of deadly diseases like AT/RT.
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Affiliation(s)
- Shih-Hwa Chiou
- Department of Medical Research and Education, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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Koral K, Gargan L, Bowers DC, Gimi B, Timmons CF, Weprin B, Rollins NK. Imaging characteristics of atypical teratoid-rhabdoid tumor in children compared with medulloblastoma. AJR Am J Roentgenol 2008; 190:809-14. [PMID: 18287456 DOI: 10.2214/AJR.07.3069] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to compare the imaging characteristics of atypical teratoid-rhabdoid tumor with medulloblastoma and seek distinguishing features that can aid in preoperative diagnosis. MATERIALS AND METHODS Preoperative MRI examinations of 55 patients (36 medulloblastomas and 19 atypical teratoid-rhabdoid tumors) were analyzed retrospectively. Imaging characteristics of atypical teratoid-rhabdoid tumor and medulloblastoma were assessed with conventional MRI and CT. Diffusion-weighted imaging (DWI) was available in 27 patients (19 medulloblastomas and eight atypical teratoid-rhabdoid tumors). Apparent diffusion coefficient (ADC) values were calculated for 14 medulloblastomas and six atypical teratoid-rhabdoid tumors. RESULTS Both atypical teratoid-rhabdoid tumors in general and infratentorial atypical teratoid-rhabdoid tumors presented at a younger age than medulloblastomas. Eleven of 19 atypical teratoid-rhabdoid tumors were infratentorial. Cerebellopontine angle (CPA) involvement was more frequent (8/11, 72.7%) in atypical teratoid-rhabdoid tumor than in medulloblastoma (4/36, 11.1%) (p < 0.001). Intratumoral hemorrhage was more common in atypical teratoid-rhabdoid tumor (9/19, 47.4%) than in medulloblastoma (2/36, 5.6%) (p < 0.0001). All atypical teratoid-rhabdoid tumors and all medulloblastomas for which DWI was available displayed increased signal intensity on DWI compared with normal brain parenchyma. The mean ADC values for tumor types were not significantly different. CONCLUSION Atypical teratoid-rhabdoid tumor presents at a younger age than medulloblastoma. Although atypical teratoid-rhabdoid tumor and medulloblastoma display similar imaging characteristics on conventional MRI, CPA involvement and intratumoral hemorrhage are more common in atypical teratoid-rhabdoid tumor. If a pediatric posterior fossa mass that displays restricted diffusion is involving the CPA, atypical teratoid-rhabdoid tumor is a more likely consideration than medulloblastoma.
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Bouvier C, De Paula AM, Fernandez C, Quilichini B, Scavarda D, Gentet JC, Figarella-Branger D. Atypical teratoid/rhabdoid tumour: 7-year event-free survival with gross total resection and radiotherapy in a 7-year-old boy. Childs Nerv Syst 2008; 24:143-7. [PMID: 17968559 DOI: 10.1007/s00381-007-0438-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 05/18/2007] [Indexed: 11/25/2022]
Abstract
CASE STUDY We report the case of a 7-year-old boy who presented in 1998 a tumour of the left frontal lobe. Initially diagnosed as anaplastic ependymoma, the boy was treated by gross total resection followed by radiotherapy at the operated site. In July 2005, an orbital tumour was discovered and resected. The tumour was composed of sheets of rhabdoid cells which diffusely expressed vimentin and focally epithelial membrane antigen (EMA) and alpha-smooth actin by immunohistochemistry. The first tumour was re-examined. Small foci of rhabdoid cells were found. Immunohistochemistry anti-INI1 performed on both tumours was negative. Molecular techniques performed on frozen specimen of the orbital tumour confirmed the diagnosis of atypical teratoid/rhabdoid tumour (ATRT). DISCUSSION We discuss the pathological criteria for diagnosis of ATRT and the usefulness of early radiotherapy in the light of the recent literature.
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Affiliation(s)
- C Bouvier
- Service d'Anatomie Pathologique et de Neuropathologie, CHU Timone, Marseilles, France
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Abstract
Reported herein is an unusual case of atypical teratoid/ rhabdoid tumor (AT/RT) of the lumbar spine with an intradural extramedullary location in a 7-year-old boy. Histologically, this tumor contained rhabdoid cells, pale cells, and sickle-shaped embracing cells without primitive neuroectodermal tumor (PNET), mesenchymal or epithelial components. Immunohistochemical staining showed that these tumor cells react positively for epithelial membrane antigen (EMA), vimentin, cytokeratin (AE1/AE3), CD99 and neurofilament protein, but negatively for INI1 antibody. Chromosome 22q deletion was demonstrated on fluorescence in situ hybridization.
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Affiliation(s)
- Chii-Shuenn Yang
- Department of Pathology, Taichung Veterans General Hospital, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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Kodama H, Maeda M, Imai H, Matsubara T, Taki W, Takeda K. MRI of primary spinal atypical teratoid/rhabdoid tumor: a case report and literature review. J Neurooncol 2007; 84:213-6. [PMID: 17361332 DOI: 10.1007/s11060-007-9359-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
Primary spinal atypical teratoid/rhabdoid tumor (AT/RT) is extremely rare. A 9-month-old boy presented with tetraparesis. Subsequent MRI showed an intradural extramedullary bulky mass extending from C4 to T6. Subtotal removal of the tumor was performed and spinal AT/RT was proven histologically. Despite chemotherapy and radiation therapy, leptomeningeal dissemination was found on follow-up MRI. The patient died 20 months after his initial symptoms. We describe the MRI findings of this case and review the literature describing this rare disease.
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Affiliation(s)
- Hiroshi Kodama
- Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
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Parmar H, Hawkins C, Bouffet E, Rutka J, Shroff M. Imaging findings in primary intracranial atypical teratoid/rhabdoid tumors. Pediatr Radiol 2006; 36:126-32. [PMID: 16341528 DOI: 10.1007/s00247-005-0037-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Revised: 08/31/2005] [Accepted: 09/07/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intracranial atypical teratoid/rhabdoid tumors (AT/RT) are rare and extremely aggressive neoplasms seen primarily in childhood. Imaging features are often considered non-specific. However, correct diagnosis of AT/RT is important because these tumors have a markedly different clinical prognosis and require more aggressive therapy. OBJECTIVE To determine the imaging features of AT/RT. MATERIALS AND METHODS We retrospectively analyzed imaging findings in 11 patients with primary intracranial AT/RT presenting over a period of 5 years. CT (n=11), MR (n=7), clinical (n=11) and pathological (n=11) features were evaluated. FISH analysis showing monosomy of chromosome 22 (absence of bcr 22q11 locus) was available for three patients. Immunohistochemical staining for INI-1 (BAF47) was performed on all tumors. RESULTS There were 11 patients, 6 boys and 5 girls. The age of presentation varied from 1 month to 15 years (average age 3 years 8 months). Six tumors were located in the posterior fossa and five in the supratentorial compartment. The tumors showed a hyperdense solid component (64%) that showed moderate to marked enhancement with contrast medium. On MR imaging, the predominant signal pattern was isointensity on T1-weighted images (57%) and T2 shortening with heterogeneity on T2-weighted images (86%). All tumors were large in size (average 4.2 x 3.7 cm), and there was a tendency for calcification (36%), hemorrhage (46%), necrosis (46%) and perifocal edema (100%). There was also a high tendency for subarachnoid dissemination, with five patients (46%) demonstrating brain and/or spinal metastasis. At follow-up (n=7), six patients showed local recurrence. At the time of recurrence, all these patients showed extensive leptomeningeal spread of the disease in both intracranial and intraspinal compartments. CONCLUSION There are no specific imaging features for intracranial AT/RT. But a high tendency toward large size, a hyperdense solid component on CT scan with calcification, hemorrhage, necrosis and subarachnoid spread suggest that this tumor should be considered in the differential diagnosis of large pediatric intracranial tumors.
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Affiliation(s)
- Hemant Parmar
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada
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