PMC4061576_01
T1-weighted MRI coronal (a) and sagittal (b) images clearly show inhomogeneously gadolinium enhancing mass in sellar turcica extending into suprasellar lesion
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F1
Magnetic resonance imaging (MRI) revealed a heterogeneously enhancing mass within suprasellar and intrasellar lesions [Figure 1].
T1-weighted MR coronal (a) and sagittal (b) images show a partial removal of the tumor after the first operation via translabial transsphenoidal approach
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F2
She underwent a partial resection, mainly caudal part of the tumor, via translabial transsphenoidal approach [Figure 2].
T1-weighted MR coronal (a) and sagittal (b) images show a partial removal of the tumor after the second operation via a basal interhemispheric approach
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F3
The second partial resection was performed, mainly ventral and rostral part of the tumor, via a basal interhemispheric approach [Figure 3], and malignant cells were not found from the surgical specimen [Figure 4].
Photomicrographs of tumor specimens obtained in the patient from the first operation. There was no malignant cells. H and E. Original magnification x100 (a) and x400 (b)
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F4
The second partial resection was performed, mainly ventral and rostral part of the tumor, via a basal interhemispheric approach [Figure 3], and malignant cells were not found from the surgical specimen [Figure 4].
T1-weighted MR coronal (a) and sagittal (b) images show an aggressive extension to the left cavernous sinus, the left orbital fossa and the left forehead with no regrowth in the sellar region
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F5
MRI demonstrated the expansion of the lesion to the left cavernous sinus, the left orbital fossa and the left forehead with no regrowth in the sellar region [Figure 5].
T1-weighted MR images (a-c) and contrast computed tomography image (d) show intracranial dissemination (arrow head) and distant metastasis in the lung (arrow head)
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F6
Furthermore, intracranial dissemination and distant metastasis were found in the right cerebellar hemisphere, vermis, spinal cord, and lung [Figure 6].
Histologically, the tumor tissue is mainly composed of hyperchromatic small cells with a relatively high nuclear/cytoplasm ratio and rhabdoid cells (H and E. Original magnification x100 (a) and x400 (b)). In immunohistochemical studies, Nestin (c), S-100 (d) and Vimentin (e) were positive and EMA (f) was focally positive. The proliferation index measured by Ki-67 was 85% in the areas of highest mitotic activity (g) and the tumor cells lack nuclear staining for the INI1 protein (h). Pathological findings were consistent with those of atypical teratoid/rhabdoid tumor
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F7
Since the tumor cells lacked nuclear expression of INI1, the tumor was pathologically diagnosed as AT/RT [Figure 7].