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Peng AJ, Fan SC, Chen YX, Huang JH, Cao Y, Zhou LX, Chen N. Atypical teratoid/rhabdoid tumor in adult: case series and an integrated survival analysis. Br J Neurosurg 2024; 38:425-432. [PMID: 33595416 DOI: 10.1080/02688697.2021.1885620] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/29/2020] [Accepted: 02/01/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumor (AT/RT) is well documented in children but less so in adults because of its rarity. METHOD We report a series of five cases, a literature review and quantitative analysis of the survival outcome of adult AT/RT patients. RESULTS Seventy-four patients including our five cases (male: female = 16: 58) were evaluated, whose median age was 32.5 years (18-80 years). The commonest location was the sellar region. Median overall survival (OS) was 12.5 months (0.5-204.00 months). Chemotherapy was associated with OS (HR: 0.349, 95%CI: 0.176-0.694, p = 0.003), while other factors did not influence OS. From Kaplan-Meier analysis, surgery combining postoperative chemotherapy and radiotherapy was associated with better prognosis (Log Rank: χ2 = 14.662, p = 0.001). CONCLUSIONS Adult AT/RT is commoner in females and tends to recur rapidly after surgical resection. Chemotherapy may provide a survival benefit. Surgery combined with postoperative chemotherapy and radiotherapy was associated with better prognosis for adult AT/RT patients, though the overall prognosis was still poor.
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Affiliation(s)
- Ai Jun Peng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shu Cai Fan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ya Xing Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Han Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Cao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Xue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ni Chen
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, China
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Gupta NK, Godbole N, Sanmugananthan P, Gunda S, Kasula V, Baggett M, Gajjar A, Kouam RW, D'Amico R, Rodgers S. Management of Atypical Teratoid/Rhabdoid Tumors in the Pediatric Population: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 181:e504-e515. [PMID: 37871692 DOI: 10.1016/j.wneu.2023.10.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumors are rare and aggressive tumors that mainly affect children <3 years of age. Despite aggressive treatment, the overall survival rate for pediatric atypical teratoid/rhabdoid tumors remains poor. Due to their rarity, little is known regarding prognostic factors, and there is no official standard of treatment. METHODS A comprehensive database search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms included "atypical teratoid rhabdoid tumor" and "atypical (teratoid OR rhabdoid) tumor." Variables of interest included, but were not limited to, age, sex, tumor location, treatment modality, extent of resection, and overall survival. RESULTS The study included 294 articles and 936 patients. The median age of patients was 22 months. There was a significant difference in survival among patients receiving surgery compared with patients receiving nonoperative treatment (50.3 months vs. 28 months; P < 0.005). Extent of resection did not significantly improve survival (P = 0.832 for gross total resection, P = 0.650 for partial resection). Combination therapy with surgical resection, radiotherapy, and chemotherapy demonstrated the largest median overall survival (54.9 months) and significantly improved survival on multivariate analysis (hazard ratio, 0.48; 95% confidence interval, 0.23-0.97; P = 0.042). CONCLUSIONS The results of this study indicate that while surgery is a crucial treatment modality for pediatric atypical teratoid/rhabdoid tumors, the effect of extent of resection is unclear. Multimodal therapy including surgery, radiotherapy, and chemotherapy is effective in improving overall survival. Future studies should focus on using larger datasets to efficiently account for confounding factors and biases.
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Affiliation(s)
- Nithin K Gupta
- Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA.
| | - Nikhil Godbole
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Praveen Sanmugananthan
- Department of Neurosurgery, Kansas City University College of Osteopathic Medicine, Kansas City, Missouri, USA
| | - Saket Gunda
- Louisiana State University Health Sciences Center, School of Medicine, New Orleans, Louisiana, USA
| | - Varun Kasula
- Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Mia Baggett
- Tulane Brain Institute, Tulane University, New Orleans, Louisiana, USA; School of Science and Engineering, New Orleans, Louisiana, USA
| | - Avi Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Romaric Waguia Kouam
- Department of Neurosurgery, Campbell University School of Osteopathic Medicine, Lillington, North Carolina, USA
| | - Randy D'Amico
- Department of Neurological Surgery, Lenox Hill Hospital, New York, New York, USA
| | - Shaun Rodgers
- Department of Neurological Surgery, Cohen Children's Medical Center, New Hyde Park, New York, USA
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Corvino S, Del Basso De Caro M, Franca RA, Corazzelli G, Della Monica R, Chiariotti L, Maiuri F. Atypical Teratoid/Rhabdoid Tumor of the Nervous System in Adults: Location-Related Features and Outcome. World Neurosurg 2023; 179:e404-e415. [PMID: 37659753 DOI: 10.1016/j.wneu.2023.08.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Atypical teratoid/rhabdoid tumor (AT/RT) of the nervous system is a rare and highly malignant neoplasm, mainly affecting children, first recognized as a pathologic entity in 1996 and added to the World Health Organization Classification of the Tumors of the Central Nervous System in 2000. AT/RT is even rarer among adults and is associated with a worse prognosis. The aim of the present study was to analyze the different tumor features according to the location in adults. METHODS A comprehensive and detailed literature review of AT/RTs in adults was made. The demographic, management, and outcome data associated with tumor location were analyzed and compared; histopathologic and molecular features were also discussed. Furthermore, we added our personal case with brain hemispheric localization and reported a progression-free survival of 103 months after gross total resection and adjuvant radiotherapy showing a peculiar histopathologic pattern. RESULTS Female sex is mainly affected by AT/RT on median localizations, both intracranial and spinal, and by all sellar region cases. Gross total resection is mainly achieved among lateral compared with median localizations. Combined radiotherapy and chemotherapy is the most adopted adjuvant treatment in all tumor localizations and is related to better outcome. Postoperative death is reported only among sellar region localizations, whereas brain hemispheric cases show the best overall survival. CONCLUSIONS AT/RTs show different and peculiar features according to their location, which significantly affects the outcome; precise knowledge of them helps the neurosurgeon in planning the best strategy for treatment.
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Affiliation(s)
- Sergio Corvino
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Corazzelli
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Rosa Della Monica
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II" of Naples, Naples, Italy
| | - Lorenzo Chiariotti
- Department of Molecular Medicine and Medical Biotechnology, University "Federico II" of Naples, Naples, Italy
| | - Francesco Maiuri
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, School of Medicine, University of Naples "Federico II", Naples, Italy.
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Atypical teratoid/rhabdoid tumor in adults: a systematic review of the literature with meta-analysis and additional reports of 4 cases. J Neurooncol 2022; 157:1-14. [PMID: 35217948 DOI: 10.1007/s11060-022-03959-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/01/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Atypical teratoid/rhabdoid tumor (AT/RT) is a highly aggressive embryonal CNS neoplasm, characterized by inactivation of SMARCB1 (INI1) or rarely of SMARCA4 (BRG1). While it is predominantly a childhood tumor, AT/RT is rare in adults. METHODS We provide a comprehensive systematic review of literature with meta-analysis; 92 adult cases were found from 74 articles. We additionally present 4 cases of adult AT/RTs (age ranging from 19 to 29 years), located to cerebellum in 2 cases, to ponto-cerebellar angle in 1 case and to spinal cord in the remaining case. RESULTS Microscopic features of our 4 cases showed a highly cellular tumor with rhabdoid morphology and high mitotic activity. All tumor cells lacked nuclear SMARCB1/INI1 protein expression. In case no. 3 we also performed methylation profiling which clustered the tumor with pediatric AT/RT-MYC subgroup. Prognosis remains poor in both pediatric and adult population with a median overall survival of 11 months. Our review demonstrated median overall survival of 15 months among the adult populations. However, consistent with a recent review, adult AT/RT seems to have highly variable prognosis and some patients reach long term survival with 22.9% of 5-year survival without evidence of disease and mean follow up time of 35.9 months (SD = 36.5). 27.1% of dissemination was also reported among the adult population. CONCLUSIONS Adult AT/RTs predominantly arise in female patients and in supratentorial location. Midline structures, including the sellar region, are the most affected sites, especially among females aged > 40 years. Male gender is more prevalent between the age of 18 and 40 years and more frequently associated with non-midline tumors. Factors significantly associated with better prognosis are patient's age (< 40 years), combined radio-chemotherapy adjuvant approach and Ki-67 score < 40%.
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Doi M, Koike J, Yoshida Y, Nakamura H, Chosokabe M, Naruki S, Tajima S, Endo A, Matsumori T, Tanaka Y. A case of an atypical teratoid/rhabdoid tumor with distinctive histology in the pineal region in an adult patient. Pathol Int 2021; 71:777-782. [PMID: 34473883 PMCID: PMC9292907 DOI: 10.1111/pin.13159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/14/2021] [Indexed: 11/26/2022]
Abstract
A 31‐year‐old man suffered from headaches and presented at a hospital after the symptom worsened. Obstructive hydrocephalus and a pineal tumor were identified, and he was transferred to our hospital for further investigation and treatment. Cranial computed tomography revealed a hypodense mass lesion on the right of the pineal region, and calcifications and enlargement of the lateral and third cerebral ventricles were also evident. Blood tests were negative for all tumor markers. Laparoscopic biopsy and third‐ventricle fenestration were performed that day as an emergency surgery to treat the obstructive hydrocephalus. Postoperative cranial magnetic resonance imaging revealed a solid tumor that was hypointense on T1‐weighted imaging, hyperintense on T2‐weighted imaging, and heterogeneously enhanced by Gd. Subsequently, the tumor increased in size, and craniotomy and tumorectomy were performed. Histologically, the tumor proliferated as round or short spindle‐shaped cells in a myxoid matrix, forming arrays that surrounded the blood vessels. As a few cells with eosinophilic cytoplasm were also present and immunostaining for INI‐1 was negative, the patient was diagnosed with atypical teratoid/rhabdoid tumor (AT/RT). AT/RT of the pineal region in adults is rare, and herein, we report the morphological characteristics of this case and reviewed the relevant literature.
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Affiliation(s)
- Masatomo Doi
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Junki Koike
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Yasuyuki Yoshida
- Department of Neurosurgery, St. Marianna University School of Medicine, Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Hisao Nakamura
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Motohiro Chosokabe
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Saeko Naruki
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shinya Tajima
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Akira Endo
- Department of Pathology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takashi Matsumori
- Department of Neurosurgery, St. Marianna University School of Medicine, Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Yuichiro Tanaka
- Department of Neurosurgery, St. Marianna University School of Medicine, Toyoko Hospital, Kawasaki, Kanagawa, Japan
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6
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Abstract
The SMARCB1/INI1 gene was first discovered in the mid-1990s, and since then it has been revealed that loss of function mutations in this gene result in aggressive rhabdoid tumors. Recently, the term "rhabdoid tumor" has become synonymous with decreased SMARCB1/INI1 expression. When genetic aberrations in the SMARCB1/INI1 gene occur, the result can cause complete loss of expression, decreased expression, and mosaic expression. Although SMARCB1/INI1-deficient tumors are predominantly sarcomas, this is a diverse group of tumors with mixed phenotypes, which can often make the diagnosis challenging. Prognosis for these aggressive tumors is often poor. Moreover, refractory and relapsing progressive disease is common. As a result, accurate and timely diagnosis is imperative. Despite the SMARCB1/INI1 gene itself and its implications in tumorigenesis being discovered over two decades ago, there is a paucity of rhabdoid tumor cases reported in the literature that detail SMARCB1/INI1 expression. Much work remains if we hope to provide additional therapeutic strategies for patients with aggressive SMARCB1/INI1-deficient tumors.
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Affiliation(s)
- Nathaniel A Parker
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Ammar Al-Obaidi
- University of Kansas School of Medicine, 1010 N Kansas St, Wichita, KS, 67214, USA
| | - Jeremy M Deutsch
- Cancer Center of Kansas, 818 N. Emporia #403, Wichita, KS, 67214, USA
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7
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Mathkour M, Carsky K, Chabot AB, Werner C, Berry JF, Carr C, Lockwood JD, Keen JR, Bui CJ, Biro EE. Adult Pineal Region Atypical Teratoid Rhabdoid Tumor: A Case for Aggressive Surgical and Chemoradiation Management with Comprehensive Literature Review. World Neurosurg 2020; 142:117-127. [PMID: 32599188 DOI: 10.1016/j.wneu.2020.06.144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atypical teratoid rhabdoid tumor (ATRT) is a rare, highly malignant central nervous system neoplasm classified as an embryonal grade IV neoplasm by the World Health Organization. ATRT generally occurs in children younger than 3 years, with 85 pathologically confirmed cases reported in adults. It is most commonly supratentorial, with only 9 confirmed adult cases localized to the pineal region. CASE DESCRIPTION The case is described of a 29-year-old man with a history of chronic migraines and a previously negative computed tomography scan of the head presenting with worsening headaches and new-onset diplopia with upward gaze palsy. Computed tomography and magnetic resonance imaging showed a hemorrhagic pineal mass with extension into the right thalamus. After resection, the immunohistochemical staining and cytogenetic profile proved consistent with ATRT, making it the ninth reported case of pineal ATRT in an adult, which was treated aggressively with good outcome. CONCLUSIONS Adult ATRT is rare, especially in the pineal region, with only 9 cases reported. Because of the aggressiveness, ATRT must be considered in the differential diagnosis of pineal region lesions because early diagnosis and aggressive treatment are key to prolonged survival.
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Affiliation(s)
- Mansour Mathkour
- Ochsner Clinic Foundation Department of Neurosurgery, New Orleans, Louisiana, USA; Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA.
| | - Katie Carsky
- Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - A Bert Chabot
- Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - Cassidy Werner
- Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - John F Berry
- Ochsner Clinic Foundation Department of Neurosurgery, New Orleans, Louisiana, USA; Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - Christopher Carr
- Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - Joseph D Lockwood
- Ochsner Clinic Foundation Department of Neurosurgery, New Orleans, Louisiana, USA; Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - Joseph R Keen
- Ochsner Clinic Foundation Department of Neurosurgery, New Orleans, Louisiana, USA; Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - Cuong J Bui
- Ochsner Clinic Foundation Department of Neurosurgery, New Orleans, Louisiana, USA; Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
| | - Erin E Biro
- Ochsner Clinic Foundation Department of Neurosurgery, New Orleans, Louisiana, USA; Tulane Medical Center Department of Neurosurgery, New Orleans, Louisiana, USA
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8
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Krill MK, Fogarty AE, Jacob S. A 71-year-old man with a rare rhabdoid brain tumour: using a multidisciplinary medical and rehabilitative model of care. BMJ Case Rep 2020; 13:13/6/e231924. [PMID: 32532899 DOI: 10.1136/bcr-2019-231924] [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: 11/04/2022] Open
Abstract
Atypical rhabdoid tumours (AT/RTs) of pineal origin are rare in adults with rapid progression and poor prognosis. We present the case of a 71-year-old man with confusion and memory loss who was diagnosed with a pineal AT/RT after genetic analysis. Due to his limited functional capacity and goal to return home with family, a multidisciplinary care approach was essential for coordination of medical management, radiation treatment and acute inpatient rehabilitation. After diagnosis and rehabilitation, his functional ability improved allowing him to tolerate cranial irradiation, initiate systemic chemotherapy and eventually returned home for a brief period with an improved quality of life. His progress was temporary due to rapid progression of the tumour. He required additional aggressive oncological treatment and was admitted for subsequent inpatient rehabilitation before opting for hospice care. This case underscores the importance of a multidisciplinary approach to cancer treatment in a patient with a rare and aggressive brain tumour, while respecting the individual goals of patients and their families.
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Affiliation(s)
- Michael K Krill
- Physical Medicine & Rehabilitation, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Alexandra E Fogarty
- Physical Medicine & Rehabilitation, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Sindhu Jacob
- Physical Medicine & Rehabilitation, Washington University in Saint Louis, Saint Louis, Missouri, USA
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9
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Thomas C, Wefers A, Bens S, Nemes K, Agaimy A, Oyen F, Vogelgesang S, Rodriguez FJ, Brett FM, McLendon R, Bodi I, Burel-Vandenbos F, Keyvani K, Tippelt S, Poulsen FR, Lipp ES, Giannini C, Reifenberger G, Kuchelmeister K, Pietsch T, Kordes U, Siebert R, Frühwald MC, Johann PD, Sill M, Kool M, von Deimling A, Paulus W, Hasselblatt M. Desmoplastic myxoid tumor, SMARCB1-mutant: clinical, histopathological and molecular characterization of a pineal region tumor encountered in adolescents and adults. Acta Neuropathol 2020; 139:277-286. [PMID: 31732806 DOI: 10.1007/s00401-019-02094-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023]
Abstract
Atypical teratoid/rhabdoid tumor (ATRT) is a highly malignant brain tumor predominantly occurring in infants. Mutations of the SMARCB1 gene are the characteristic genetic lesion. SMARCB1-mutant tumors in adolescents and adults are rare and may show uncommon histopathological and clinical features. Here we report seven SMARCB1-deficient intracranial tumors sharing distinct clinical, histopathological and molecular features. Median age of the four females and three males was 40 years (range 15-61 years). All tumors were located in the pineal region. Histopathologically, these tumors displayed spindled and epithelioid cells embedded in a desmoplastic stroma alternating with a variable extent of a loose myxoid matrix. All cases showed loss of nuclear SMARCB1/INI1 protein expression, expression of EMA and CD34 was frequent and the Ki67/MIB1 proliferation index was low in the majority of cases (median 3%). Three cases displayed heterozygous SMARCB1 deletions and two cases a homozygous SMARCB1 deletion. On sequencing, one tumor showed a 2 bp deletion in exon 4 (c.369_370del) and one a short duplication in exon 3 (c.237_276dup) both resulting in frameshift mutations. Most DNA methylation profiles were not classifiable using the Heidelberg Brain Tumor Classifier (version v11b4). By unsupervised t-SNE analysis and hierarchical clustering analysis, however, all tumors grouped closely together and showed similarities with ATRT-MYC. After a median observation period of 48 months, three patients were alive with stable disease, whereas one patient experienced tumor progression and three patients had succumbed to disease. In conclusion, our series represents an entity with distinct clinical, histopathological and molecular features showing epigenetic similarities with ATRT-MYC. We propose the designation desmoplastic myxoid tumor (DMT), SMARCB1-mutant, for these tumors.
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Affiliation(s)
- Christian Thomas
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, Münster, Germany
| | - Annika Wefers
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Susanne Bens
- Institute of Human Genetics, University of Ulm and Ulm University Hospital, Ulm, Germany
| | - Karolina Nemes
- Swabian Childrens' Cancer Center, University Childrens' Hospital Augsburg and EU-RHAB Registry, Augsburg, Germany
| | - Abbas Agaimy
- Institute of Pathology, University of Erlangen, Erlangen, Germany
| | - Florian Oyen
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Vogelgesang
- Institute of Pathology, Department of Neuropathology, University Medicine Greifswald, Greifswald, Germany
| | | | - Francesca M Brett
- Department of Neuropathology, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Roger McLendon
- Department of Pathology, Duke University, Durham, NC, USA
| | - Istvan Bodi
- Department of Clinical Neuropathology, King's College Hospital NHS Foundation Trust, London, UK
| | - Fanny Burel-Vandenbos
- Central Laboratory of Pathology, Nice University Hospital, Hôpital Pasteur, Nice, France
| | - Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany
| | - Stefan Tippelt
- Department of Pediatric Oncology and Hematology, Pediatrics III, University Hospital Essen, Essen, Germany
| | - Frantz R Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Eric S Lipp
- Preston Robert Tisch Brain Tumor Center, Duke University, Durham, NC, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
- German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Düsseldorf, Germany
| | - Klaus Kuchelmeister
- Institute of Neuropathology and DGNN Brain Tumor Reference Centre, University of Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology and DGNN Brain Tumor Reference Centre, University of Bonn, Bonn, Germany
| | - Uwe Kordes
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reiner Siebert
- Institute of Human Genetics, University of Ulm and Ulm University Hospital, Ulm, Germany
| | - Michael C Frühwald
- Swabian Childrens' Cancer Center, University Childrens' Hospital Augsburg and EU-RHAB Registry, Augsburg, Germany
| | - Pascal D Johann
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Sill
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Marcel Kool
- Hopp-Children's Cancer Center (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Andreas von Deimling
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, Münster, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Pottkamp 2, Münster, Germany.
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10
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Monteiro J, Santiago B, Manilha R, Viegas C, Oliveira A, Cunha e Sá M. Adult Atypical Teratoid/Rhabdoid Tumor in the Pineal Region: Case Report and Literature Review. World Neurosurg 2020; 134:428-433. [DOI: 10.1016/j.wneu.2019.11.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022]
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11
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Ng PM, Low PH, Liew DNS, Wong ASH. Radiation-induced malignant rhabdoid tumour of the hypothalamus in an adult: A case report. World J Clin Oncol 2019; 10:375-381. [PMID: 31815097 PMCID: PMC6894999 DOI: 10.5306/wjco.v10.i11.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 10/10/2019] [Accepted: 10/15/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rhabdoid tumours of the central nervous system are highly malignant and extremely rare in adults. To the best of our knowledge, only 87 cases of malignant rhabdoid tumour have been reported to date, inclusive of 4 cases with presumed radiation-induced aetiology. We report a case of malignant rhabdoid tumour in an adult with presumed radiation-induced aetiology to enrich the armamentarium of this disease entity, which may have some implications for early diagnosis and treatment of this rare disease in the future.
CASE SUMMARY A 27-year-old male, who was exposed to cranial irradiation at the age of 4 years as part of the treatment for acute lymphoblastic leukaemia, presented with symptoms of raised intracranial pressure for one week. Brain magnetic resonance imaging revealed a heterogeneously enhancing lesion at the hypothalamus. Stereotactic biopsy was performed. Histopathological examination of the lesion showed malignant rhabdoid tumour. The disease progressed rapidly, with manifestation of leptomeningeal spread. He was started on craniospinal irradiation but treatment was suspended after 5.4 Gy, as he developed myelosuppression. His clinical condition deteriorated rapidly, and he succumbed to his illness within 2 mo.
CONCLUSION This fifth case of radiation-induced central nervous system rhabdoid tumour re-enforces the aggressive nature of this disease with poor prognosis.
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Affiliation(s)
- Pei-Meng Ng
- Department of Neurosurgery, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia
| | - Peh-Hueh Low
- Department of Neurosurgery, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia
| | - Donald Ngian-San Liew
- Department of Neurosurgery, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia
| | - Albert Sii-Hieng Wong
- Department of Neurosurgery, Sarawak General Hospital, Kuching 93586, Sarawak, Malaysia
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Chan V, Marro A, Findlay JM, Schmitt LM, Das S. A Systematic Review of Atypical Teratoid Rhabdoid Tumor in Adults. Front Oncol 2018; 8:567. [PMID: 30547013 PMCID: PMC6279935 DOI: 10.3389/fonc.2018.00567] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022] Open
Abstract
Background: Atypical teratoid/rhabdoid tumor in adults is a relatively rare malignant neoplasm. It is characterized by the presence of rhabdoid cells in combination with loss of either the INI1 or BRG1protein from the tumor cells. Methods: A systematic review was conducted using MEDLINE using the terms “atypical teratoid rhabdoid tumor” AND “adult.” The systematic review was supplemented with relevant articles from the references. Cases were included if the pathology was confirmed by loss of INI1 or BRG1. We included a case from our institution. The dataset was analyzed using descriptive statistics and log-rank test. Results: A total of 50 cases from 29 articles were included in this study. The average age at diagnosis was 36.7 years. The most common locations reported are the sellar region and cerebral hemispheres (without deep gray matter involvement). Of the 50 cases, 14 were reported to show evidence of dissemination. The average overall survival was 20 months. There was a significant difference in survival between the adjuvant therapy groups (p = < 0.0001). Conclusion: Atypical teratoid rhabdoid tumor of the central nervous system in adults is a rare neoplasm associated with a poor prognosis in a majority of patients. The treatment and clinical course are highly variable, and it remains unclear which factors impact prognosis.
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Affiliation(s)
- Vivien Chan
- Division of Neurosurgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Alessandro Marro
- Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - J Max Findlay
- Division of Neurosurgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Laura M Schmitt
- Division of Neuropathology, University of Alberta Hospital, Edmonton, AB, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Sumit Das
- Division of Neuropathology, University of Alberta Hospital, Edmonton, AB, Canada.,Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
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Kolin DL, Dong F, Baltay M, Lindeman N, MacConaill L, Nucci MR, Crum CP, Howitt BE. SMARCA4-deficient undifferentiated uterine sarcoma (malignant rhabdoid tumor of the uterus): a clinicopathologic entity distinct from undifferentiated carcinoma. Mod Pathol 2018; 31:1442-1456. [PMID: 29700418 DOI: 10.1038/s41379-018-0049-z] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/25/2018] [Accepted: 02/04/2018] [Indexed: 12/22/2022]
Abstract
Small cell carcinoma of the ovary, hypercalcemic type is a rare, aggressive malignancy which usually occurs in young women and is characterized by mutations in SMARCA4, with few other alterations. We recently encountered uterine tumors with morphologic, immunohistochemical, and genetic similarities to small cell carcinoma of the ovary, hypercalcemic type. Herein we report the clinicopathologic and molecular features (using a targeted massively parallel sequencing [MPS] assay) of these tumors. The cases were diagnosed on cervical and endometrial biopsies (n = 2, 34, and 29 years) or hysterectomy and bilateral salpingo-oophorectomy (n = 3, 25, 33, and 58 years). The tumors were composed of sheets of large atypical epithelioid cells with prominent rhabdoid morphology, indistinguishable from the "large cell" variant of small cell carcinoma of the ovary, hypercalcemic type. In three cases, the ovaries were pathologically examined to exclude a primary ovarian malignancy. Immunohistochemically, four of four cases showed SMARCA4 loss, and were negative or only focally positive for keratins, EMA, and claudin-4. One of three cases was positive for WT-1. Targeted MPS was successfully performed on 4 of 5 tumors, and showed recurrent mutations in SMARCA4, with few other alterations. Of the cases diagnosed on hysterectomy, all had extensive lymphovascular invasion, extra-uterine spread, and marked infiltrative growth. These tumors were uniformly aggressive; all patients died of disease (median survival 7 months, range 1-43 months). We propose this entity be called "SMARCA4-deficient undifferentiated uterine sarcoma (malignant rhabdoid tumor of the uterus)", a term which describes both the tumor's underlying molecular abnormality and its morphology. Its unique clinicopathologic and molecular features differentiate it from other related malignancies, including undifferentiated endometrial carcinoma, small cell carcinoma of the ovary (hypercalcemic type), and epithelioid sarcoma. We review and discuss previously reported "rhabdoid tumors of the uterus;" while they are a heterogenous group of tumors, some of them are likely examples of this entity. Correctly identifying cases of SMARCA4-deficient uterine sarcoma from histologic mimics is important as it may have prognostic, predictive, and germline implications.
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Affiliation(s)
- David L Kolin
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Fei Dong
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Michele Baltay
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Neal Lindeman
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Laura MacConaill
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Marisa R Nucci
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Christopher P Crum
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Brooke E Howitt
- Division of Women's and Perinatal Pathology, Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA. .,Department of Pathology, Stanford University Medical Center, Stanford, CA, 94305, USA.
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15
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Atypical teratoid/rhabdoid tumour following craniopharyngioma radiotherapy during childhood. Childs Nerv Syst 2016; 32:1573-5. [PMID: 27461272 DOI: 10.1007/s00381-016-3187-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 07/07/2016] [Indexed: 12/15/2022]
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Wu WW, Bi WL, Kang YJ, Ramkissoon SH, Prasad S, Shih HA, Reardon DA, Dunn IF. Adult Atypical Teratoid/Rhabdoid Tumors. World Neurosurg 2016; 85:197-204. [DOI: 10.1016/j.wneu.2015.08.076] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 08/23/2015] [Accepted: 08/24/2015] [Indexed: 12/17/2022]
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17
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Sugita Y, Terasaki M, Tanigawa K, Ohshima K, Morioka M, Higaki K, Nakagawa S, Shimokawa S, Nakashima S. Gliosarcomas arising from the pineal gland region: uncommon localization and rare tumors. Neuropathology 2015; 36:56-63. [DOI: 10.1111/neup.12226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yasuo Sugita
- Departments of Pathology; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Mizuhiko Terasaki
- Departments of Neurosurgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Ken Tanigawa
- Departments of Pathology; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Koichi Ohshima
- Departments of Pathology; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Motohiro Morioka
- Departments of Neurosurgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Koichi Higaki
- Department of Pathology, St. Mary's Hospital; Kurume Japan
| | | | - Shoko Shimokawa
- Department of Neurosurgery, St. Mary's Hospital; Kurume Japan
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The expanding family of SMARCB1(INI1)-deficient neoplasia: implications of phenotypic, biological, and molecular heterogeneity. Adv Anat Pathol 2014; 21:394-410. [PMID: 25299309 DOI: 10.1097/pap.0000000000000038] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the description of atypical teratoid/rhabdoid tumors of the central nervous system and renal/extrarenal malignant rhabdoid tumors in children, the clinicopathologic spectrum of neoplasms having in common a highly variable rhabdoid cell component (0% to 100%) and consistent loss of nuclear SMARCB1 (INI1) expression has been steadily expanding to include cribriform neuroepithelial tumor of the ventricle, renal medullary carcinoma and a subset of collecting duct carcinoma, epithelioid sarcoma, subsets of miscellaneous benign and malignant soft tissue tumors, and rare rhabdoid carcinoma variants of gastroenteropancreatic, sinonasal, and genitourinary tract origin. Although a majority of SMARCB1-deficient neoplasms arise de novo, the origin of SMARCB1-deficient neoplasia in the background of a phenotypically or genetically definable differentiated SMARCB1-intact "parent neoplasm" has been convincingly demonstrated, highlighting the rare occurrence of rhabdoid tumors as "double-hit neoplasia." As a group, SMARCB1-deficient neoplasms occur over a wide age range (0 to 80 y), may be devoid of rhabdoid cells or display uniform rhabdoid morphology, and follow a clinical course that varies from benign to highly aggressive causing death within a few months irrespective of aggressive multimodality therapy. Generally applicable criteria that would permit easy recognition of these uncommon neoplasms do not exist. Diagnosis is based on site-specific and entity-specific sets of clinicopathologic, immunophenotypic, and/or molecular criteria. SMARCB1 immunohistochemistry has emerged as a valuable tool in confirming or screening for SMARCB1-deficient neoplasms. This review summarizes the different phenotypic and topographic subgroups of SMARCB1-deficient neoplasms including sporadic and familial, benign and malignant, and rhabdoid and nonrhabdoid variants, highlighting their phenotypic heterogeneity and molecular complexity.
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Kanoto M, Toyoguchi Y, Hosoya T, Kuchiki M, Sugai Y. Radiological image features of the atypical teratoid/rhabdoid tumor in adults: a systematic review. Clin Neuroradiol 2014; 25:55-60. [PMID: 24477665 DOI: 10.1007/s00062-013-0282-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Atypical teratoid/rhabdoid tumor (AT/RT) occurs in children less than 3 years old, and has a very poor prognosis. AT/RT seldom occurs in adult. We have experienced four cases of AT/RT at our institute. The purpose of this study is to evaluate the radiological image findings of adult-onset AT/RT and to conduct a systematic review. METHODS Image findings of four AT/RTs in our institute were retrospectively evaluated by an experienced neuroradiologist. If the images were unavailable, image findings were evaluated from the former image interpretation report. We assembled papers of adult-onset AT/RT (n = 38) and evaluated the image findings. RESULTS AT/RT occurs in a variety of sites (spinal region, pineal region, suprasellar region, jugular foramen, and so on). High density on computed tomography (CT) was seen in 10 of 11 cases; mixed intensity in T2-weighted image was seen in 13 of 18 cases; and high intensity on diffusion-weighted image (DWI) was seen in 3 of 3 cases. Contrast enhancement was observed in all cases in which images were available. CONCLUSIONS We have experienced four adult-onset AT/RT cases at our institute and have evaluated image findings through systematic review. The image findings of high density on CT, high intensity on DWI, with low apparent diffusion coefficient, and a heterogenous component should lead to an inclusion of AT/RT in the differential diagnosis of a tumor; these findings may be able to suggest AT/RT; however, they cannot make the diagnosis.
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Affiliation(s)
- M Kanoto
- Department of Diagnostic Radiology, Yamagata University Faculty of Medicine, Iida-Nishi 2-2-2, 990-9585, Yamagata, Japan,
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