J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Case Report

Volume 9, Number 3, March 2017, pages 216-220

Atypical Teratoid/Rhabdoid Tumor of the Sellar Region in an Adult With Long Survival: Case Report and Review of the Literature

Figures

Figure 1. Baseline pituitary MRI. T1-weighted MRI coronal (a) and sagittal (b) images show large intrasellar mass with suprasellar extension compressing and displacing the optic chiasm with evidence of tumor ischemia, bilateral invasion of cavernous sinus and clivus with posterior destruction of clinoid.

Figure 2. Tumor is composed of sheets of undifferentiated cells with large area of necrosis (H&E stain, ×100 magnifications).

Figure 3. Tumor cells have oval nuclei and prominent nucleoli with focal eosinophilic globular inclusions (H&E stain, × 1,000 magnification with oil).

Figure 4. INI-1 (BAF47) immunostain shows loss of nuclear staining in the tumor nuclei and retention of nuclear staining in the lymphocytes and endothelial cells (× 400 magnification).

Figure 5. Postoperative pituitary. T1-weighted MRI coronal (a) and sagittal (b) images show small residual tumor affecting left side of sella with evidence of empty sella, stable displaced pituitary stalk and down displaced optic chiasm.

Figure 6. Latest pituitary MRI. T1-weighted MRI coronal (a) and sagittal (b) images show stable empty sella. Stable deformed left-sided displaced pituitary stalk as well as of down displacement of the optic chiasm and the floor of the third ventricle with focal enhancement of the optic chiasm remains unchanged since the previous study.

Tables

**Table 1.** Serial Pituitary Hormone Profile
Date	FSH (IU/L)	LH (IU/L)	Prolactin (mL/L) (102 - 496)	Cortisol (nmol/L)	TSH (mIU/L) (0.27 - 4.2)	ACTH (pmol/L) (1.6 - 13.9)	FT4 (pmol/L) (12.0 - 22.0)
December 2013 (baseline)	0.5	0.2	350	16	< 0.005	0.1	8
January 2014	0.4	< 0.11	212	33	< 0.005	-	15.6
May 2014	0.5	< 0.11	337	19	0.024	< 0.22	11.7
August 2015	0.2	< 0.1	263	42	0.25	< 0.22	10.7
November 2016	0.2	< 0.1	240	6	0.009	0.3	17.2

**Table 2.** Summary of Previously Described Cases of Sellar AT/RT and the Present Case
Age	Sex	Presentation	Treatment	Outcome	Reference
20	F	Vision loss	Resection, radiation, and chemotherapy	Alive at 28 months	[11]
31	F	Not described	Resection and radiation	Died at 9 months	[11]
56	F	Headache and diplopia	Resection and radiation	Died at 23 months	[12]
61	F	Sixth cranial nerve palsy	Resection	Died at 3 months	[13]
57	F	Headache, diplopia, third CN palsy	Resection, radiation, and chemotherapy	Alive at 6 months	[13]
44	F	Visual disturbance	Resection, radiation, and chemotherapy	Died at 17 months	[14]
60	F	Headache and diplopia	Resection, radiation, and chemotherapy	Died at 30 months	[15]
46	F	Headache	Not described	Not described	[16]
43	F	Headache and diplopia	Resection and radiation	Alive at 2 weeks	[17]
36	F	Headache and blurred vision	Resection, radiation, and chemotherapy	Died at 29 months	[10]
35	F	Headache, diplopia, and amenorrhea	Resection, radiation, and chemotherapy	Alive at 37 months	Present case