Liu Fujun, Fan Shucai, Tang Xin, Fan Shuangmin, Zhou Liangxue
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Front Neurol. 2020 Dec 15;11:604612. doi: 10.3389/fneur.2020.604612. eCollection 2020.
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. 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. Patients ( = 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 ( = 0.033), and that patients who received post-operative combination radio- and chemotherapy had longer OS than that of those who did not ( < 0.001). 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.
成人鞍区非典型畸胎样/横纹肌样瘤(AT/RT)是一种罕见病变。我们旨在阐明该疾病的临床、影像学和病理特征、治疗策略及预后。对2015年1月至2018年12月期间的5例成人鞍区AT/RT患者进行了回顾性分析。此外,我们还对已报道的成人鞍区AT/RT数据进行了综述。患者(n = 5)均为女性,中位年龄50岁。症状的平均持续时间为1.6个月(范围2周 - 8个月),其中头痛最为常见。平均肿瘤大小为2.82 cm(范围1.9 - 4.5 cm)。所有病变形状不规则。MRI显示5个病变中有3个呈不均匀强化。5例患者中4例行次全切除(STR),1例行全切除(GTR)。其中,1例患者接受术后辅助放疗,1例患者接受术后放化疗联合治疗。对已报道数据的综述显示,已报道成人鞍区AT/RT共39例。估计中位总生存期(OS)为23个月,1年生存率估计为59.7%。GTR患者的中位OS为28个月,STR患者为17个月。Kaplan - Meier分析显示,MIB - 1/Ki67指数值高(≥35%)的患者与低(<35%)指数值的患者相比,OS显著缩短(P = 0.033),且接受术后放化疗联合治疗的患者OS长于未接受者(P < 0.001)。成人鞍区AT/RT是一种生长迅速、预后不良的肿瘤。组织学上MIB1/Ki - 67水平高可能提示肿瘤具有侵袭性。最大安全切除后联合辅助放疗和化疗可能是成人鞍区AT/RT的最佳治疗策略。