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Kiyose M, Herrmann E, Roesler J, Zeiner PS, Steinbach JP, Forster MT, Plate KH, Czabanka M, Vogl TJ, Hattingen E, Mittelbronn M, Breuer S, Harter PN, Bernatz S. MR imaging profile and histopathological characteristics of tumour vasculature, cell density and proliferation rate define two distinct growth patterns of human brain metastases from lung cancer. Neuroradiology 2023; 65:275-285. [PMID: 36184635 PMCID: PMC9859874 DOI: 10.1007/s00234-022-03060-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Non-invasive prediction of the tumour of origin giving rise to brain metastases (BMs) using MRI measurements obtained in radiological routine and elucidating the biological basis by matched histopathological analysis. METHODS Preoperative MRI and histological parameters of 95 BM patients (female, 50; mean age 59.6 ± 11.5 years) suffering from different primary tumours were retrospectively analysed. MR features were assessed by region of interest (ROI) measurements of signal intensities on unenhanced T1-, T2-, diffusion-weighted imaging and apparent diffusion coefficient (ADC) normalised to an internal reference ROI. Furthermore, we assessed BM size and oedema as well as cell density, proliferation rate, microvessel density and vessel area as histopathological parameters. RESULTS Applying recursive partitioning conditional inference trees, only histopathological parameters could stratify the primary tumour entities. We identified two distinct BM growth patterns depending on their proliferative status: Ki67high BMs were larger (p = 0.02), showed less peritumoural oedema (p = 0.02) and showed a trend towards higher cell density (p = 0.05). Furthermore, Ki67high BMs were associated with higher DWI signals (p = 0.03) and reduced ADC values (p = 0.004). Vessel density was strongly reduced in Ki67high BM (p < 0.001). These features differentiated between lung cancer BM entities (p ≤ 0.03 for all features) with SCLCs representing predominantly the Ki67high group, while NSCLCs rather matching with Ki67low features. CONCLUSION Interpretable and easy to obtain MRI features may not be sufficient to predict directly the primary tumour entity of BM but seem to have the potential to aid differentiating high- and low-proliferative BMs, such as SCLC and NSCLC.
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Affiliation(s)
- Makoto Kiyose
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt am Main, Germany ,Department of Neurology, University Hospital, Frankfurt am Main, Germany ,Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute for Biostatistics and Mathematical Modelling, University Hospital, Frankfurt am Main, Germany
| | - Jenny Roesler
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany
| | - Pia S. Zeiner
- Department of Neurology, University Hospital, Frankfurt am Main, Germany ,Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany ,Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Joachim P. Steinbach
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany ,Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - Karl H. Plate
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg ,Laboratoire National de Santé (LNS), Dudelange, Luxembourg ,Luxembourg Center of Neuropathology (LCNP), Dudelange, Luxembourg ,Department of Cancer Research (DoCR), Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg ,Department of Life Sciences and Medicine (DLSM), University of Luxembourg, Esch-sur-Alzette, Luxembourg ,Faculty of Science, Technology and Medicine (FSTM)S, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Stella Breuer
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Patrick N. Harter
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Simon Bernatz
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany ,Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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A rare case of multifocal atypical teratoid rhabdoid tumor. Radiol Case Rep 2022; 18:495-498. [PMID: 36439916 PMCID: PMC9691412 DOI: 10.1016/j.radcr.2022.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/27/2022] Open
Abstract
Atypical rhabdoid teratoid tumor of the primary central nervous system is an uncommon and highly aggressive tumor that often affects infants and young children. Approximately two-thirds of tumors start in the posterior fossa. The best treatment for atypical rhabdoid teratoid tumor is yet unknown. Chemotherapy, radiation, and surgery are available as treatment options. Their respective roles are yet not each well defined. The prognosis for atypical rhabdoid teratoid tumor is absolutely poor. In this article, we intended to introduce a very rare case of multifocal atypical rhabdoid teratoid tumor in a 7-year-old boy.
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Karim A, Shaikhyzada K, Suleimenova A, Ibraimov B, Nurgaliev D, Poddighe D. Case report: Atypical teratoid/rhabdoid tumor of the lateral ventricle in a male adolescent (case-based review and diagnostic challenges in developing countries). Front Oncol 2022; 12:985862. [PMID: 36276064 PMCID: PMC9582653 DOI: 10.3389/fonc.2022.985862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/06/2022] [Indexed: 12/04/2022] Open
Abstract
Atypical teratoid/rhabdoid tumor (AT/RT) is a rare and highly malignant central nervous system (CNS) embryonal neoplasm: it accounts for <2% of all pediatric CNS tumors and occurs mainly in infants and young children. The primary site of this tumor is usually the posterior cranial fossa. Supratentorial and, in detail, latero-ventricular location is extremely uncommon, especially in adolescents. This tumor is characterized by rapid growth and spread in cerebrospinal fluid and, therefore, it is characterized by a poor prognosis. Neurological signs and symptoms are related the location of the tumor. The radiological features of AT/RT are nonspecific. Immunohistochemical staining for loss of nuclear integrase interactor 1 (INI1) expression is considered a reliable criterion for the diagnosis of this type of tumor. AT/RT has been linked to mutations of SMARCB1 or, rarely, SMARCA4 genes, which function as tumor suppressor genes. Currently, there is no validated protocol of treatment for children with AT/RT, and multimodality treatment (consisting of surgery, chemotherapy, and radiation therapy) is considered. In this case report, we describe a 15-year-old adolescent with an AT/RT of the left lateral ventricle. Despite the late diagnosis, the multimodal therapeutic approach provided a good outcome for our patient at 21 months' follow-up. Based on our case-based review, early diagnosis and a multimodal approach to treatment play a key role in improving the survival of patients with this diagnosis. Implementing a system supporting pathological and molecular analyses for developing countries and, in general, for non-academic centers is of primary importance to timely diagnose and treat rare tumors, such as AT/RT.
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Affiliation(s)
- Akzhol Karim
- Clinical Academic Department of Pediatrics, Pediatric Oncology Section, National Research Center for Maternal and Child Health, University Medical Center (UMC), Nur-Sultan, Kazakhstan
| | - Kundyz Shaikhyzada
- Clinical Academic Department of Pediatrics, Pediatric Oncology Section, National Research Center for Maternal and Child Health, University Medical Center (UMC), Nur-Sultan, Kazakhstan
| | - Assel Suleimenova
- Clinical Academic Department of Pediatrics, Pediatric Oncology Section, National Research Center for Maternal and Child Health, University Medical Center (UMC), Nur-Sultan, Kazakhstan
| | - Bakytkali Ibraimov
- Clinical Academic Department of Laboratory Medicine, Pathology Section, University Medical Center (UMC), Nur-Sultan, Kazakhstan
| | - Dair Nurgaliev
- Clinical Academic Department of Pediatrics, Pediatric Oncology Section, National Research Center for Maternal and Child Health, University Medical Center (UMC), Nur-Sultan, Kazakhstan
| | - Dimitri Poddighe
- Clinical Academic Department of Pediatrics, Pediatric Oncology Section, National Research Center for Maternal and Child Health, University Medical Center (UMC), Nur-Sultan, Kazakhstan,Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan,*Correspondence: Dimitri Poddighe,
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Extra-axial, dural-based atypical teratoid/rhabdoid tumor. Childs Nerv Syst 2022; 38:655-658. [PMID: 33944990 DOI: 10.1007/s00381-021-05196-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
Atypical teratoid/rhabdoid tumors (ATRTs) are malignant central nervous system tumors that affect early childhood (< 3 years), and mostly located in the infratentorial space. Owing to an infrequent occurrence, their radiological features have not been completely defined. Nevertheless, these are characteristically intra-axial except for few instances in the cerebellopontine angle region. We describe a case of a 10-year-old boy who harbored an extra-axial, dural-based ATRT in the right parietal region. The lesion was totally excised followed by adjuvant chemo-radiotherapy. At 10-month follow-up, he was well with no recurrence. The report intends to highlight an atypical imaging presentation of ATRT in an older child, and adds to the radiological spectrum. This uncommon pathology should be borne in mind, even in a supratentorial dural-based location.
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Meng L, Wang L, Shao G. Relapsing cerebral atypical teratoid/rhabdoid tumor after trimodality therapy: A case report. Medicine (Baltimore) 2021; 100:e27986. [PMID: 34964793 PMCID: PMC8615398 DOI: 10.1097/md.0000000000027986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Atypical teratoid rhabdoid tumor (AT/RT) is a high-grade embryonal malignant neoplasm of the central nervous system. It is rare and most often diagnosed in children <4 years of age. The biological manifestations of AT/RTs are highly malignant and have a very poor prognosis. Here, we present the case of a 16-year-old boy with AT/RT in the right parietal lobe and with a dismal outcome. PATIENT CONCERNS A 16-year-old male boy presented with a headache after waking up for 1 year without obvious cause. The pain was persistent and dull, mainly in the right orbital, and was slightly relieved after pressing the orbital. Occasionally, nausea and vomiting occurred, and the vomiting was gastric contents. Examination and head computed tomography performed at a local hospital revealed a space-occupying lesion in the right parietal lobe. The patient was then transferred to our hospital for further diagnosis and treatment. DIAGNOSIS The patient underwent craniotomy and gross total excision of the tumor. Further histologic examination of the tumor was identified (space-occupying lesion in the right parietal lobe) AT/RT, World Health Organization grade IV. INTERVENTIONS The patient was transferred to the oncology department for radiotherapy and chemotherapy after surgery recovery. OUTCOMES The patient did not comply with the advice for adjuvant chemotherapy regularly and the tumor recurred rapidly. Finally, the patient died after 18 months after the definitive surgery. CONCLUSION In conclusion, in the presence of a tumor with peripheral cystic components or hemorrhage in young children, a diagnosis of AT/RT must always be considered. Patients must follow the doctor's advice for active treatment. All relevant data are within the paper and its Supporting Information files.
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Mitsui N, Oikawa K, Tanino M, Kinoshita M. SMARCB1 (INI1) retained but SMARCA4 (BRG1) negative atypical teratoid/rhabdoid tumor arising at the bilateral cerebellopontine angles: a case report. J Surg Case Rep 2021; 2021:rjab400. [PMID: 34611487 PMCID: PMC8485679 DOI: 10.1093/jscr/rjab400] [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: 07/18/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Most atypical teratoid/rhabdoid tumor (AT/RT) of the central nervous system shows an inactivation of SMARCB1 (INI1) and is considered as the hallmark of this neoplasm. However, AT/RT could exceptionally rarely present retained SMARCB1 (INI1) but inactivated SMARCA4 (BRG1). Here, the authors report a rare case of a 2-year-old boy with a SMARCB1 (INI1) retained but SMARCA4 (BRG1) negative AT/RT arising at the bilateral cerebellopontine angles mimicking neurofibromatosis type 2. The tumor was highly aggressive and was refractory to all treatment modalities. This case highlights the challenges during differential diagnosis of atypical cerebellopontine angle tumors of childhood and the importance of thoroughly investigating SMARCB1 (INI1) and SMARCA4 (BRG1) when AT/RT is suspected.
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Affiliation(s)
- Nobuyuki Mitsui
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
| | - Kensuke Oikawa
- Department of Pathology, Asahikawa Medical University, Asahikawa, Japan
| | - Mishie Tanino
- Department of Diagnostic Pathology, Asahikawa Medical University Hospital, Asahikawa, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Japan
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Hamrick FA, Karsy M, Bruggers CS, Putnam AR, Hedlund GL, Cheshier SH. Developmentally anomalous cerebellar encephalocele arising within the cerebellopontine angle and extending into the adjacent skull base in a pediatric patient. Childs Nerv Syst 2021; 37:2943-2947. [PMID: 33566142 PMCID: PMC8423691 DOI: 10.1007/s00381-020-05020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
Lesions of the cerebellopontine angle (CPA) in young children are rare, with the most common being arachnoid cysts and epidermoid inclusion cysts. The authors report a case of an encephalocele containing heterotopic cerebellar tissue arising from the right middle cerebellar peduncle and filling the right internal acoustic canal in a 2-year-old female patient. Her initial presentation included a focal left 6th nerve palsy. Magnetic resonance imaging was suggestive of a high-grade tumor of the right CPA. The lesion was removed via a retrosigmoid approach, and histopathologic analysis revealed heterotopic atrophic cerebellar tissue. This report is the first description of a heterotopic cerebellar encephalocele within the CPA and temporal skull base of a pediatric patient.
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Affiliation(s)
- Forrest A. Hamrick
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Michael Karsy
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113 USA
| | - Carol S. Bruggers
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT USA ,Division of Neuro-Oncology, Department of Pediatrics, University of Utah, Salt Lake City, UT USA
| | - Angelica R. Putnam
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT USA ,Department of Pathology, University of Utah, Salt Lake City, UT USA
| | - Gary L. Hedlund
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT USA ,Department of Medical Imaging, Primary Children’s Hospital, University of Utah, Salt Lake City, UT USA
| | - Samuel H. Cheshier
- Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113 USA ,Primary Children’s Hospital, University of Utah, Salt Lake City, UT USA
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Spinal Atypical Rhabdoid Teratoid Tumor in an Adult Woman: Case Report and Review of the Literature. World Neurosurg 2019; 128:196-199. [PMID: 31082562 DOI: 10.1016/j.wneu.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Atypical rhabdoid teratoid tumors are very rare embryonal tumors that typically affect children younger than 3 years old and are encountered intracranially. CASE DESCRIPTION Here, we describe the case of a 19-year-old woman who presented with gait disturbances and coccydynia. Imaging revealed a cauda equina mass. The tumor was partially resected. Histology reported loss of SMARCB1/INI1 expression and therefore the diagnosis of atypical rhabdoid teratoid was established. The patient underwent radiation treatment, but within 3 months 2 relapses were manifested. CONCLUSIONS Atypical rhabdoid teratoids are exceptionally rare in adults and are seldom found in spine; only 8 such cases have been reported in the medical literature. They are invariantly characterized by multiple relapses and dismal prognosis. The clinician must be attentive of leptomeningeal disseminations and 22q11 deletion-associated comorbidities.
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Spontaneous Mediastinal Abscess and Sternal Cleft in the Medically Complex Neonate. J Craniofac Surg 2019; 30:e558-e561. [PMID: 30939557 DOI: 10.1097/scs.0000000000005502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sternal cleft (SC) is a rare congenital anomaly, occurring with associated developmental anomalies or in isolation. Surgery to reconstruct the sternum is indicated to protect the visceral organs from trauma, to ensure healthy cardiopulmonary function and growth, and to reconstruct the anterior chest wall. Although infection recognized as a postoperative complication following chest wall reconstruction, spontaneous mediastinal infection is rare. To the authors' knowledge, there is only 1 reported case of spontaneous mediastinal infection with concomitant SC in the literature. Here, the authors present a unique case of a medically complicated infant with a SC who presented with a spontaneous mediastinal abscess.
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Shen Z, Wang N, Shi W, Zhang P, Weng J, Zeng H. Atypical teratoid rhabdoid tumor mimicking type II neurofibromatosis: A case report. Medicine (Baltimore) 2019; 98:e14308. [PMID: 30702605 PMCID: PMC6380747 DOI: 10.1097/md.0000000000014308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Brain magnetic resonance imaging (MRI) images of atypical teratoid rhabdoid tumor (ATRT) often present heterogeneous signals of various cells without remarkable features of the disease. We describe a unique case of atypical brain MRI images presenting as an type II neurofibromatosis and explore some diagnostic hints. PATIENT CONCERNS A 1-year-and-7-month-old boy admitted to our department with a 7-day history of drowsiness and 2-day history of emesis, and his presenting complaint was repeated vomit. On physical examination, he had drowsiness, positive sun set sign, slow light reflection, high muscular tension of limbs and 55 cm head circumference. MRI presented masses of bilateral auditory nerve distribution area, the fourth ventricle and right frontal lobe, obstructive hydrocephalus, and amplified cisterna magna. Particularly, dumbbell shape tumor in left cerebellopontine angle area and the fourth ventricle showed iso- or hypo-intensity on T1-weighted image and mix-intensity on T2-weighted image with irregular frontier, obvious mutual high and low signal on T2-weighted image, and growing along cerebrospinal fluid pathway. DIAGNOSIS The diagnosis of type II neurofibromatosis (NF-II) was considered pre-operatively. After surgery, postoperative histopathology confirmed the diagnosis of ATRT. INTERVENTIONS After ventriculo-peritoneal (VP) shunt, no evidence of tumor was inspected in cerebrospinal fluid, and enhancement MRI showed heterogeneous contrast signal on dumbbell shape tumor. We executed an incomplete microsurgery for dumbbell shape lesion in left auditory nerve distribution area and the fourth ventricle for differential diagnosis and facilitating further treatment. OUTCOMES The patient did not recover well postoperatively and suffered from severe pulmonary infection. Refusing further intervention in view of poor prognosis of ATRT, the patient was transferred to another hospital for rehabilitation care. The patient died from progressive tumor and respiratory failure after 2 months. LESSONS The diagnosis of ATRT can be challenging, in our case due to the disturbance of bilateral auditory nerve distribution area tumors. Under MRI, Irregular frontier, obvious mutual high and low signal on T2-weighted image, growing along cerebrospinal fluid pathway, and heterogeneous contrast enhancement should lead the clinician to strongly consider ATRT.
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A Case Presentation: Rare Occurrence of an Adolescent Male Presenting With an ATRT and Simultaneous Low-grade Glioneuronal Tumor. J Pediatr Hematol Oncol 2017; 39:e456-e459. [PMID: 28731919 DOI: 10.1097/mph.0000000000000871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Atypical rhabdoid/teratoid tumor (ATRT) is an uncommon and highly malignant tumor of the central nervous system. The majority of ATRT tumors occur in infancy and young children located in the posterior fossa. The ideal treatment for cure remains controversial and prognosis is typically unfavorable. We present a case of an atypical presentation of ATRT, presenting in adolescence with an additional low-grade glioneuronal tumor discovered at diagnosis.
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Katz JS, Peruzzi PP, Pierson CR, Finlay JL, Leonard JR. Cerebellopontine angle tumors in young children, displaying cranial nerve deficits, and restricted diffusion on diffusion-weighted imaging: a new clinical triad for atypical teratoid/rhabdoid tumors. Childs Nerv Syst 2017; 33:833-838. [PMID: 28332155 DOI: 10.1007/s00381-017-3384-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
Atypical teratoid/rhabdoid tumors (AT/RT) of the central nervous system (CNS) are rare, highly malignant neoplasms that carry a poor prognosis. Even with prompt diagnosis, gross total resection and early initiation of intensive adjuvant therapy, the majority of patients will succumb within 9-12 months of diagnosis. The CPA location in children harbors lesions along a wide spectrum varying from benign to highly malignant. Imaging features of lesions within the CPA that aid the diagnostic process will help to initiate early treatment in higher-grade lesions. We report three cases, in very young children, all with cranial nerve deficits, who displayed CPA lesions with restricted diffusion on diffusion-weighted imaging (DWI) with pathology confirming AT/RT. We propose that in young children with a CPA tumor diffusion-weighted imaging should be routinely evaluated to aid in prompt management. In addition, the diagnosis of AT/RT should be highly suggestive in infants presenting with cranial nerve findings as well as DWI restricted diffusion within the CPA.
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Affiliation(s)
- Joel S Katz
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.,Department of Neurosurgery, Grant Medical Center, Columbus, OH, USA
| | - Pier Paolo Peruzzi
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.,Department of Neurosurgery, Ohio State University, Columbus, OH, USA
| | - Christopher R Pierson
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pathology and Division of Anatomy, The Ohio State University, Columbus, OH, USA
| | - Jonathan L Finlay
- Department of Neurosurgery, Ohio State University, Columbus, OH, USA.,Department of Hematology and Oncology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jeffrey R Leonard
- Division of Pediatric Neurosurgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. .,Department of Neurosurgery, Ohio State University, Columbus, OH, USA.
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Freiburg neuropathology case conference : Brainstem tumor in a child. Clin Neuroradiol 2016; 26:377-83. [PMID: 27605108 DOI: 10.1007/s00062-016-0535-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Investigation of the location of atypical teratoid/rhabdoid tumor. Childs Nerv Syst 2015; 31:1305-11. [PMID: 25953096 DOI: 10.1007/s00381-015-2739-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/27/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The location of a brain tumor is a fundamental characteristic, because various brain tumors develop in relatively specific locations. An atypical teratoid/rhabdoid tumor (AT/RT) is a highly age-specific tumor that occurs in infants and young children. However, AT/RTs develop in a variety of locations in the brain. This study aimed at uncovering the tumor location pattern of AT/RTs to enhance diagnoses. MATERIAL AND METHODS Neuroimages from 27 patients with a pathologically proven AT/RT were reviewed, and the specific tumor locations were described and categorized. The association of imaging characteristics and tumor location was analyzed. RESULTS The posterior fossa was the most frequent locations accounting for 19 patients (70%), followed by the diencephalon (four patients; 15%), cerebrum (three patients; 11%), and midbrain (one patient; 4%). In the posterior fossa, the superior medullary velum (SMV) and cerebellopontine angle (CPA) areas were the most common sites (eight patients each) and three patients had a tumor in the inferior medullary velum (IMV) region. AT/RTs in the SMV area had a significantly higher chance of no/minimal enhancement compared with tumors in other locations (P = 0.001) and a lower likelihood of leptomeningeal tumor seeding at presentation (P = 0.053). CONCLUSION The location spectrum of AT/RT follows a specific pattern, and some of the locations are linked with intriguing clinical characteristics. This information may not only help make correct preoperative diagnosis but also occasionally aid in postoperative pathological diagnosis.
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Afif M, Khalil J, Kouhen F, Aissa A, Omour Y, Elkabous M, Elkacemi H, Kebdani T, Benjaafar N. [About a rare case of atypical rhabdoid teratoid tumor of the central nervous system in a pregnant woman]. Pan Afr Med J 2015; 20:2. [PMID: 25995799 PMCID: PMC4430151 DOI: 10.11604/pamj.2015.20.2.5877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 12/13/2014] [Indexed: 12/05/2022] Open
Abstract
Les tumeurs rhabdoïdes tératoïdes atypiques du système nerveux central sont des tumeurs pédiatriques rares et de mauvais pronostic. La littérature rapporte une dizaine de cas chez l'adulte dont deux survenus au cours d'une grossesse. Nous rapportons dans ce travail, le cas d'une femme de 25 ans, enceinte de 14 semaines d'aménorrhée, qui a été opérée pour une tumeur rhabdoïde tératoïde atypique de la fosse cérébrale postérieure. Un complément thérapeutique a été discuté chez la patiente après interruption thérapeutique de grossesse, mais la patiente fut décédée avant de démarrer le traitement adjuvant. Nous décrivons brièvement les caractéristiques des tumeurs rhabdoïdes, et les particularités de sa prise en charge chez l'adulte.
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Affiliation(s)
- Mohammed Afif
- Service de Radiothérapie, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
| | - Jihane Khalil
- Service de Radiothérapie, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
| | - Fadila Kouhen
- Service de Radiothérapie, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
| | - Abdellah Aissa
- Service de Radiothérapie, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
| | - Youssef Omour
- Service de Radiologie, Institut National d'Oncologie de Rabat, Université Mohammed V, Rabat, Maroc
| | - Mustapha Elkabous
- Service d'Oncologie Médicale, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
| | - Hanan Elkacemi
- Service de Radiothérapie, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
| | - Tayeb Kebdani
- Service de Radiothérapie, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
| | - Noureddine Benjaafar
- Service de Radiothérapie, Institut National d'Oncologie, Université Mohammed V, Rabat, Maroc
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Wang X, Liu X, Lin Z, Chen Y, Wang P, Zhang S. Atypical teratoid/rhabdoid tumor (AT/RT) arising from the acoustic nerve in a young adult: a case report and a review of literature. Medicine (Baltimore) 2015; 94:e439. [PMID: 25634176 PMCID: PMC4602954 DOI: 10.1097/md.0000000000000439] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Atypical teratoid/rhabdoid tumors (AT/RTs) are rare, highly malignant central nervous system tumors that predominantly occur in young children. A 22-year-old woman presented with a 4-year history of relapsing tinnitus and gradual hearing loss. Neuroimaging revealed an enhanced intrinsic left internal auditory canal mass. The patient underwent radiotherapy treatment. Three years later, the tumor size continued to increase, as observed by imaging, and ultimately evolved into the left cerebellopontine angle. As a consequence, a total tumor resection was performed, and a pathological diagnosis of AT/RT was made. Aggressive radiotherapy and chemotherapy treatment continued; however, the tumor recurred within 11 months after the total tumor resection. The patient died within 4 months of the second operation. Histopathologically, the tumor contained characteristic rhabdoid cells with areas that resembled a classical primitive neuroectodermal tumor. Immunostaining showed loss of INI1 protein expression in tumor cells, and fluorescence in situ hybridization showed a hemizygous deletion of the hSNF5/INI1 gene region on 22q11.2. This is the first report of an AT/RT that arised from the acoustic nerve in a young adult. Despite manifold diagnostic and therapeutic advances, the prognosis of patients with AT/RT remains poor.
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Affiliation(s)
- Xingfu Wang
- From the Department of Pathology (XW, XL, YC, PW, SZ); and Department of Neurosurgery (XL), the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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17
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Sinha P, Ahmad M, Varghese A, Parekh T, Ismail A, Chakrabarty A, Tyagi A, Chumas P. Atypical teratoid rhabdoid tumour of the spine: report of a case and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S472-84. [PMID: 25374299 DOI: 10.1007/s00586-014-3445-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 06/28/2014] [Accepted: 06/29/2014] [Indexed: 12/12/2022]
Abstract
Atypical teratoid rhabdoid tumour (ATRT) is a rare and highly aggressive malignant neoplasm of the central nervous system (CNS), which occurs predominantly in children less than 2 years of age. There are less than 50 cases described in adult. We report a case of primary spinal ATRT in a 65-year-old male who presented to us with cauda equina syndrome. To the best of our knowledge, our patient is the (1) second oldest patient to be diagnosed with ATRT and only the third case of adult spinal ATRT report in the literature; (2) first reported case of CNS ATRT occurring in a patient with non-rhabdoid renal cancer; (3) first adult patient of ATRT to present with cauda equina syndrome.
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Affiliation(s)
- Priyank Sinha
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, LS1 3EX, UK,
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18
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[Infant rhabdoid tumors: a diagnostic emergency]. Arch Pediatr 2014; 21:1246-9. [PMID: 25267195 DOI: 10.1016/j.arcped.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 08/06/2014] [Indexed: 11/20/2022]
Abstract
Rhabdoid tumors are a heterogeneous family of aggressive tumors affecting young children. Their grouping within a single entity is recent, following the discovery of a bi-allelic inactivation of the hSNF5/INI1 tumor suppressor gene in tumoral cells. This bi-allelic inactivation of the hSNF5/INI1 gene found at the constitutional level in up to one-third of cases has led to the identification of a predisposal syndrome to rhabdoid tumors. Herein we report extrarenal rhabdoid tumors observed in three infants between 3 and 6 months of age, underlining the misleading feature of the clinical presentation and the aggressiveness of the disease. Finally, we also report the genetic patient care management strategy.
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19
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Muzumdar D, Ventureyra ECG. Treatment of posterior fossa tumors in children. Expert Rev Neurother 2014; 10:525-46. [DOI: 10.1586/ern.10.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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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: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [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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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] [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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Han L, Qiu Y, Xie C, Zhang J, Lv X, Xiong W, Wang W, Zhang X, Wu P. Atypical teratoid/rhabdoid tumors in adult patients: CT and MR imaging features. AJNR Am J Neuroradiol 2010; 32:103-8. [PMID: 21051520 DOI: 10.3174/ajnr.a2361] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Primary AT/RT is a rare highly malignant tumor of the CNS, usually occurring in children younger than 5 years of age. The objective of this study was to characterize the CT and MR imaging findings in a series of 5 adult patients with pathologically proved AT/RT. All 5 AT/RTs were supratentorial. In 2 patients who underwent nonenhanced CT, the tumors appeared isoattenuated, and 1 of the 2 tumors contained calcifications. Solid portions of the tumors on MR imaging were isointense on T1-weighted, T2-weighted, and FLAIR images, and 1 case showed restricted diffusion on DWI. The tumors also demonstrated a bandlike rim of strong enhancement surrounding a central cystic area on contrast-enhanced T1-weighted imaging. One tumor was associated with destruction of the calvaria. Although AT/RTs can have nonspecific findings, the tumors in our series were large and isointense on T1-weighted, T2-weighted, and FLAIR images with central necrosis and prominent rim enhancement.
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Affiliation(s)
- L Han
- Department of Medical Imaging and Interventional Radiology, Cancer Center, Sun Yat-Sen University, Guangzhou, PR China
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Lee IH, Kim JH, Suh YL, Eo H, Shin HJ, Yoo SY, Lee KS. Imaging characteristics of pilomyxoid astrocytomas in comparison with pilocytic astrocytomas. Eur J Radiol 2010; 79:311-6. [PMID: 20619565 DOI: 10.1016/j.ejrad.2010.06.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 06/03/2010] [Accepted: 06/09/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Pilomyxoid astrocytoma (PMA) is a recently described astrocytic tumor that has been previously diagnosed as pilocytic astrocytoma (PA). The purpose of this study was to describe the imaging features of PMAs in comparison with PAs. MATERIALS AND METHODS We retrospectively reviewed CT/MR images and medical records of 10 patients with PMA and 38 patients with PA. The mean ages of patients with PMA and PA were 10 and 15 years, respectively. Imaging features including location, composition, enhancement pattern, presence of calcification, hemorrhage, and leptomeningeal dissemination were compared in patients with two tumor types. RESULTS Six PMAs (60%) occurred at the suprasellar area and the cerebellum was the most common (45%) site of PA. Solid component was dominant in eight PMAs (80%) and in 19 PAs (50%). All of the PMAs containing solid mass (n=8) included non-enhancing portion while 12/37 (32%) PAs included non-enhancing solid portion (p<0.05). Leptomeningeal dissemination was noted in five PMAs (50%) and one PA (3%) (p<0.05). Other imaging findings were not significantly different. CONCLUSION A younger age, more frequent occurrence at the suprasellar area, mainly solid mass containing non-enhancing portion, and more frequent leptomeningeal dissemination are helpful differential features of PMAs as compared to PAs.
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Affiliation(s)
- In Ho Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Gangnam-Gu, Seoul 135-710, Republic of Korea.
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Les tumeurs rhabdoïdes : des tumeurs hSNF5/INI1-déficientes précoces et agressives. Bull Cancer 2010; 97:37-45. [DOI: 10.1684/bdc.2009.1024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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