PMC9582653_01
Preoperative (A) T2 axial magnetic resonance imaging (MRI); (B) T2 FLAIR axial MRI; (C) T2 sagittal MRI demonstrating mass in the left lateral ventricle with heterogeneous enhancement measuring 7.2 cm x 4.7 x 5 cm, composed of both cystic and solid areas, and extending to the frontal lobe of the brain; Postoperative (D) T1 axial magnetic resonance imaging (MRI); (E) T2 weighted image axial MRI; (F) T1 contrasted coronal MRI demonstrates the area of postoperative cystic change and residual tumor measuring 1.3 cm x 1.1 x 1 cm, actively accumulating contrast agent; contrasted T1 axial (G, H) and coronal (I) MRI at 17-month follow-up, which shows residual tumor measuring 4.5 x 3.2 mm (H) and 4.3 x 2.6 mm (G).
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The first cranial MRI (before neurosurgery) reported a contrast-enhanced mass in the left periventricular region with involvement of the left basal ganglia, head of the caudate nucleus, thalamus, until the frontal lobe and body of the lateral ventricle ( Figures 1A-C ). Brain MRI performed on the 2nd day after surgery showed a residual tumor measuring 1.3 x 1.1 x 1 cm in the region of the left lateral ventricle ( Figures 1D-F ). At 21 months' follow-up, the patient is alive and a further decrease in the size of the residual tumor was shown ( Figures 1G-I ).
Histologic specimen with features consistent with atypical teratoid/rhabdoid tumor. Glial fibrillary acidic protein (A) and epithelial membrane antigen (B) immunochemistry demonstrates diffuse positivity. Cytokeratin AE1/AE3 (C) was not positive in tumor cells. The proliferative activity of tumor cells is high, the Ki-67 index is 40-50% (D).
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Furthermore, tumor cells demonstrated strongly immunopositivity for vimentin and microtubule-associated protein two, and focal immunopositivity for epithelial membrane antigen and GFAP ( Figure 2 ).