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Sellar Atypical Teratoid/Rhabdoid Tumor (AT/RT): A Clinicopathologically and Genetically Distinct Variant of AT/RT.

鞍区非典型畸胎样/横纹肌样肿瘤(AT/RT):一种临床病理和遗传学上具有独特性的AT/RT变异型

Nakata S,Nobusawa S,Hirose T,Ito S,Inoshita N,Ichi S,Amatya VJ,Takeshima Y,Sugiyama K,Sonoda Y,Haga H,Hirato J,Nakazato Y,Yokoo H

Abstract

Atypical teratoid/rhabdoid tumors (AT/RTs) are rare aggressive tumors of the central nervous system that predominantly affect infants. Although adult AT/RT are rare, accumulated cases have revealed adult-specific AT/RT in the sellar region. Twelve previously reported cases of sellar AT/RT exclusively occurred in adult females, suggesting biological differences from conventional infant AT/RT. We herein investigated a series of 6 sellar AT/RT for histopathologic features, the molecular status of the INI1/SMARCB1 gene, and clinical courses. All 6 cases were adult females, ranging in age from 21 to 69 years old. Tumors were histologically characterized by a hemangiopericytoma-like stag-horn vasculature within a dense, diffuse proliferation of jumbled cells and a small number of scattered rhabdoid cells. This vascular pattern is not a common finding in AT/RT and appears to be a characteristic histology of sellar AT/RT. Biallelic alterations in the INI1 gene were identified by fluorescence in situ hybridization, direct sequencing, and multiple ligation-dependent probe amplification analyses in 4 of the 5 cases analyzed. Three of the 4 cases harbored 2 different mutations, presumably on different alleles (compound heterozygous mutations), and 1 case of which had a splice-site mutation. Combined with previous findings, the prevalence of compound heterozygous mutations and splice-site mutations was significantly higher in sellar AT/RT than in pediatric AT/RT. Sellar AT/RT represent a clinicopathologically and possibly genetically distinct variant of AT/RT showing a characteristic demography, different patterns of INI1 alterations, and a histology featured by a unique vasculature.

摘要

非典型畸胎样/横纹肌样肿瘤(AT/RTs)是一种主要发生于婴幼儿中枢神经系统的罕见、侵袭性肿瘤。尽管成人的AT/RT非常少见,但以往的病例已有发生于鞍区的成人特异性AT/RT。12例先前报道的鞍区AT/RT均发生于成年女性,并且与传统的婴幼儿AT/RT具有生物学差异。我们分析了6例鞍区AT/RT的组织病理学特征、INI1/SMARCB1基因的分子状态以及临床资料。所有病例均为成年女性,年龄从21岁到69岁不等。肿瘤以血管外皮瘤样的鹿角状血管伴以密集、弥漫增生的杂乱细胞和小部分成簇的横纹肌样细胞为组织学特征。这种血管模式在AT/RT中并不常见,并且似乎是鞍区AT/RT特有的组织学特征。通过荧光原位杂交、直接测序和多重连接依赖性探针扩增分析发现,5例病例中有4例具有INI1基因的双向改变。4例病例中有3例存在2种不同的突变,可能在不同的位点(复合杂合突变),1例具有剪接位点突变。结合以上发现,鞍区AT/RT的复合杂合突变和剪接位点突变的发生率显著高于婴幼儿AT/RT。鞍区AT/RT代表一种独特的变异型,临床病理学具有特殊性,可能基因方面也不同与AT/RT,它具有特征性的发病人群、INI1突变模式不同且血管具有独特的组织学形态。



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