PMC5369260_01
Pre-operative MRI. Clockwise from top left: T1 sagittal with contrast, T1 sagittal without contrast, T2 sagittal, T2 axial, T1 axial with contrast
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F1
MRI documented a C1-3 intradural, extramedullary, ventrolateral mass nearly filling the spinal canal resulting in severe compression of the upper cervical cord. Marked cord edema, seen on the T2 image, was present from C5 through the medulla [Figure 1]. The final diagnosis was ATRT [Figures 1 and 5].
Postoperative MRI. Clockwise from top left: T1 sagittal with contrast, T2 sagittal, T2 axial, T1 axial with contrast
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F2
She was immediately placed on intravenous steroids and taken to the operating room for a C1-3 decompressive laminectomy and gross total resection of the tumor [Figure 2].
H and E stain. Sheets of polygonal rhabdoid tumor cells separated by an anastomosing capillary network. The rhabdoid cell is characterized with a large eccentric vesicular nucleus with a prominent nucleolus containing a round cytoplasmic eosinophilic inclusion
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F3
The pathological diagnosis proved to be consistent with an ATRT [Figures 3-5]. [Figures 3 and 5] Histopathological examination of the intradural, extramedullary, cervical spine tumor showed sheets of polygonal cells separated into small groups by a network of endothelial cell-lined capillaries.
INI staining. Immunohistochemical stain for INI1 showing abnormal loss of nuclear staining of the rhabdoid cells with normal nuclear staining of the capillary endothelial cells and infiltrating lymphocytes. Very faint staining of the cytoplasmic inclusion is noted
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F4
The pathological diagnosis proved to be consistent with an ATRT [Figures 3-5].
Electron microscopy. EM picture of a rhabdoid cell showing the vesicular nucleus with a large nucleolus and a pale whorled aggregate of intermediate filament displacing the formed cytoplasmic organelles
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F5
The pathological diagnosis proved to be consistent with an ATRT [Figures 3-5]. [Figures 3 and 5] Histopathological examination of the intradural, extramedullary, cervical spine tumor showed sheets of polygonal cells separated into small groups by a network of endothelial cell-lined capillaries. The final diagnosis was ATRT [Figures 1 and 5].