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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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Liu F, Fan S, Tang X, Fan S, Zhou L. Adult Sellar Region Atypical Teratoid/Rhabdoid Tumor: A Retrospective Study and Literature Review. Front Neurol 2021; 11:604612. [PMID: 33384656 PMCID: PMC7769810 DOI: 10.3389/fneur.2020.604612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/16/2020] [Indexed: 02/04/2023] Open
Abstract
Background: Adult sellar region atypical teratoid/rhabdoid tumor (AT/RT) is a rare lesion. We aimed to elucidate clinical, radiologic, and pathological characteristics, treatment strategies, and outcomes of this disease. Methods: Five adult sellar AT/RT patients were retrospectively analyzed between January 2015 and December 2018. In addition, we performed a review of the reported data on adult sellar AT/RT. Results: Patients (n = 5) were female with a median age of 50 years. The mean duration of symptoms, of which headache was the most frequent, was 1.6 months (range, 2 weeks−8 months). The average tumor size was 2.82 cm (range, 1.9–4.5 cm). All lesions were irregularly shaped. MRI showed heterogeneous enhancement in three of five lesions. Four of five patients underwent subtotal resection (STR) and one gross total resection (GTR). Whereas, one patient received post-operative adjuvant radiotherapy, one patient received post-operative combination of radio- and chemotherapy. The review of the reported data showed that 39 cases of adult sellar AT/RT had been reported. The estimated median overall survival (OS) was 23 months with a 1-year survival estimate of 59.7%. The median OS for patients with GTR was 28 months and 17 months for patients with STR. Kaplan–Meier analysis showed that patients with high (≥35%) MIB-1/Ki67 index value had a significantly shorter OS compared with those with low (<35%) index value (p = 0.033), and that patients who received post-operative combination radio- and chemotherapy had longer OS than that of those who did not (p < 0.001). Conclusion: Adult sellar region AT/RT is a rapidly growing tumor with a poor prognosis. High levels of MIB1/Ki-67 on histology may indicate aggressive feature of the tumor. Maximal safe resection followed by adjuvant radiotherapy combined with chemotherapy may be the optimal therapeutic strategy for adult sellar region AT/RT.
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Affiliation(s)
- Fujun Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shucai Fan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Shuangmin Fan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liangxue Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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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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Siddiqui M, Thoms D, Samples D, Caron J. Atypical teratoid/rhabdoid tumor presenting with subarachnoid and intraventricular hemorrhage. Surg Neurol Int 2019; 10:139. [PMID: 31528474 PMCID: PMC6744721 DOI: 10.25259/sni-59-2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/26/2019] [Indexed: 01/04/2023] Open
Abstract
Background: Sellar masses comprise 14–18% of all intracranial tumors. Pituitary adenomas account for 85% of these lesions, while 15% of sellar masses stem from other etiologies. Intratumoral hemorrhage (apoplexy), while not exceptionally common, can be discovered at presentation. While the hemorrhage pattern is typically contained within the tumor, an extension of bleeding beyond the sella has been reported. Case Description: A 55-year-old female presented with an anterior interhemispheric subarachnoid hemorrhage and extensive intraventricular hemorrhage (IVH). Initially, the IVH was thought to be due to a ruptured aneurysm. After further workup, a hemorrhagic sellar mass was diagnosed. The patient underwent transsphenoidal resection of a pituitary adenoma. The patient returned to the emergency department6 weeks later with an atypical rapidly expanding sellar mass. After tumor debulking, the pathology revealed an atypical teratoid/rhabdoid tumor (ATRT). Here, we reviewed this and other such cases of sellar ATRT. Conclusion: The early diagnosis of sellar ATRT with lack of integrase interactor 1 expression and elevated Ki67 proliferation indices can prompt more aggressive attempted gross total resection, chemotherapy, and radiation treatments.
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Affiliation(s)
- Mehdi Siddiqui
- Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Dewey Thoms
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Derek Samples
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, United States
| | - Jean Caron
- Department of Neurosurgery, University of Texas Health San Antonio, San Antonio, Texas, United States
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Voisin MR, Ovenden C, Tsang DS, Gupta AA, Huang A, Gao AF, Diamandis P, Almeida JP, Gentili F. Atypical Teratoid/Rhabdoid Sellar Tumor in an Adult with a Familial History of a Germline SMARCB1 Mutation: Case Report and Review of the Literature. World Neurosurg 2019; 127:336-345. [PMID: 31004861 DOI: 10.1016/j.wneu.2019.04.083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Adult sellar atypical teratoid/rhabdoid tumor (ATRT) is a rare diagnosis that has recently been shown to be a clinicopathologically and genetically distinct variant of ATRT occurring almost exclusively in middle-aged women. Although up to one third of pediatric ATRT is caused by a familial syndrome, no previous cases of a familial adult sellar ATRT have been reported. We present the first case report of a familial germline mutation causing adult sellar ATRT and a literature review of 29 previously reported cases of sporadic adult sellar ATRT. CASE DESCRIPTION A 51-year-old woman with a family history of brain tumors spanning 3 generations presented with visual decline and was diagnosed with an adult sellar ATRT. Genetic studies showed a heterozygous splice-site loss-of-function mutation of the INI1 gene in exon 7. Treatment included endoscopic endonasal biopsy, craniospinal irradiation, and focal tumor boost, followed by adjuvant chemotherapy. CONCLUSIONS This is the first case report of a familial germline mutation causing adult sellar ATRT. This article highlights the importance of a thorough family history and genetic testing in these individuals and reviews the current genetics, histopathology, and multidisciplinary treatment approach in this rare condition.
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Affiliation(s)
- Mathew R Voisin
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Chris Ovenden
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Abha A Gupta
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Annie Huang
- Pediatric Brain Tumor Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew F Gao
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Phedias Diamandis
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Joao P Almeida
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Fred Gentili
- Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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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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Nishikawa A, Ogiwara T, Nagm A, Sano K, Okada M, Chiba A, Agata M, Kaneko T, Tamada H, Uehara T, Hongo K. Atypical teratoid/rhabdoid tumor of the sellar region in adult women: Is it a sex-related disease? J Clin Neurosci 2018; 49:16-21. [DOI: 10.1016/j.jocn.2017.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/04/2017] [Indexed: 01/19/2023]
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Barresi V, Lionti S, Raso A, Esposito F, Cannavò S, Angileri FF. Pituitary atypical teratoid rhabdoid tumor in a patient with prolactinoma: A unique description. Neuropathology 2017; 38:260-267. [DOI: 10.1111/neup.12440] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Valeria Barresi
- Department of Human Pathology in Adulthood and Evolutive Age; University of Messina; Messina Italy
| | - Simona Lionti
- Department of Human Pathology in Adulthood and Evolutive Age; University of Messina; Messina Italy
| | - Alessandro Raso
- Unit of Neurosurgery; Giannina Gaslini Institute; Genoa Italy
| | - Felice Esposito
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging; University of Messina; Messina Italy
| | - Salvatore Cannavò
- Department of Human Pathology in Adulthood and Evolutive Age; University of Messina; Messina Italy
| | - Filippo F. Angileri
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging; University of Messina; Messina Italy
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