Clinicopathologic analysis of Wilms’ tumor – A retrospective study of 35 cases over 10 years.
Keywords:
Wilms’ tumor, Pediatrics, Triphasic
Abstract
Background: Wilms’ tumor is the commonest pediatric renal tumor and has a peak incidence between two and five years of age. Clinicopathological staging of Wilms’ tumor is the single most important prognostic determinant and therefore histopathological analysis is important.Methods: This is a retrospective study of diagnosed cases of Wilms’ tumor received as surgical and autopsy specimens in the department of pathology in a major teaching hospital over a period of ten years. Clinical, biochemical and radiological details were retrieved from medical records. Information regarding routine gross and microscopic examination findings (paraffin sections) was retrieved from departmental recordsResult: We received 24 nephrectomies, three post mortem specimens and eight biopsies. Maximum cases were found between two to five years of age with no gender predilection. Most patients presented with abdominal lump. Grossly, majority specimens had a variegated cut surface whereas two cases had a predominantly cystic appearance. Microscopically, 26 cases showed classic triphasic histology. Eight out of 27 cases (nephrectomies and post mortem cases) received preoperative chemotherapy. All cases showed extensive chemotherapeutic response and one case showed post – chemotherapy change mimicking a cystic partially differentiated nephroblastoma (CPDN). Of the remaining 19 cases which did not receive chemotherapy, only one case had an unfavorable histology. A rare case of CPDN was reported.Conclusion: Histopathologist plays an important role in the diagnosis of Wilms tumor. Clinical, radiological and pathological correlation is necessary in the final reporting of these cases.DOI:10.21276/APALM.1606References
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9. Liubimova NV. The significance of changes in lactate dehydrogenase activity for the diagnosis and effective treatment of nephroblastoma in children. Vopr Onkol.1994; 40:319-322.
10. Miniati D, Gay AN, Parks KV, Naik- Mathuria BJ, Hicks J, Nuchtern JG, et al. Imaging accuracy and incidence of Wilms' and non-Wilms' renal tumors in children. J Pediatr Surg. 2008; 43:1301-1307.
11. Mukta Ramadwar. In: Saral S Desai, Munita Bal, Bharat Rekhi, Nirmala Jhambekar, editors. Grossing of surgical oncology specimens.1 ed: Tata Memorial Hospital; 2011:1-232.
12. Dome JS1, Cotton CA, Perlman EJ, Breslow NE, Kalapurakal JA, Ritchey ML, et al. Treatment of anaplastic histology Wilms' tumor: results from the fifth National Wilms' Tumor Study. J Clin Oncol. 2006; 24:2352-2358.
13. Joshi VV, Beckwith JB. Multilocular cyst of the kidney (cystic nephroma) and cystic, partially differentiated nephroblastoma: terminology and criteria for diagnosis. Cancer.1989; 64:466-479.
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15. Bhatnagar S. Management of Wilms' tumor: NWTS vs SIOP. J Indian Assoc Pediatr Surg.2009;14:6-14
16. Guarda LA, Ayala AG, Jaffe N, Sutow WW, Bracken RB. Chemotherapy induced histologic changes in Wilms' tumors. Pediat Pathol. 1984; 2:197-206
17. Jagt CT, Zuckermann M, Ten Kate F, Tamirniau JA, Dijkgraaf MG, Heij H, et al. Veno-occlusive disease as a complication of preoperative chemotherapy for Wilms tumor: A clinico-pathological analysis. Pediatr Blood Cancer. 2009; 53:1211-1215.
2. Daw NC, Huff V, Anderson PM. Neoplasms of the kidney. In: Richard E Behrman, editor. Nelson Textbook of pediatrics.20th ed: Elsevier Inc: 2016: 2464 -2468
3. B. Guruprasad, B. Rohan, S. Kavitha, D. S. Madhumathi, D. Lokanath, and L. Appaji. Wilms’ Tumor: Single Centre Retrospective Study from South India. Indian J Surg Oncol. 2013; 4: 301-304.
4. M Mazumder, A Islam, N Farooq, M Zaman. Clinicopahological Profile of Wilms’ Tumour in Children. J Bangladesh Coll of Phys Surg. 2014; 32: 5-8.
5. T Nuznath, P Saldanha. Histopathological study of Kidney tumors in children. International Medical Journal [Internet]. 2016 Oct [cited Jul 2017]; 3(10) : 880-883:[about 1p]. Available from http://www.medpulse.in.
6. Das RN, Chatterjee U, Sinha SK, Ray AK, Saha K, Banerjee S. Study of histopathological features and proliferation markers in cases of Wilms’ tumor. Indian J Pediatr Oncol.2012; 33:102-106.
7. Hung IJ, Chang WH, Yang CP, Jaing TH, Liang DC, Lin KH, et al. Epidemiology, clinical features and treatment outcome of Wilms' tumor in Taiwan: a report from Taiwan Pediatric Oncology Group. J Formos Med Assoc. 2004 Feb; 103:104-11.
8. Yao W, Li K, Xiao X, Gao J, Dong K, Xiao X, et al. Outcomes of Wilms’ Tumor in Eastern China: 10 Years of Experience at a Single Center. J Invest Surg. 2012; 25:181-185.
9. Liubimova NV. The significance of changes in lactate dehydrogenase activity for the diagnosis and effective treatment of nephroblastoma in children. Vopr Onkol.1994; 40:319-322.
10. Miniati D, Gay AN, Parks KV, Naik- Mathuria BJ, Hicks J, Nuchtern JG, et al. Imaging accuracy and incidence of Wilms' and non-Wilms' renal tumors in children. J Pediatr Surg. 2008; 43:1301-1307.
11. Mukta Ramadwar. In: Saral S Desai, Munita Bal, Bharat Rekhi, Nirmala Jhambekar, editors. Grossing of surgical oncology specimens.1 ed: Tata Memorial Hospital; 2011:1-232.
12. Dome JS1, Cotton CA, Perlman EJ, Breslow NE, Kalapurakal JA, Ritchey ML, et al. Treatment of anaplastic histology Wilms' tumor: results from the fifth National Wilms' Tumor Study. J Clin Oncol. 2006; 24:2352-2358.
13. Joshi VV, Beckwith JB. Multilocular cyst of the kidney (cystic nephroma) and cystic, partially differentiated nephroblastoma: terminology and criteria for diagnosis. Cancer.1989; 64:466-479.
14. Argani P, Beckwith BJ. Renal neoplasms of childhood. In: Stacy E Mills, editor. Stacy E Mills’s Sternberg’s Diagnostic Surgical Pathology. 5th ed: Lippincott Williams and Wilkins: 2010: 1799 – 1828.
15. Bhatnagar S. Management of Wilms' tumor: NWTS vs SIOP. J Indian Assoc Pediatr Surg.2009;14:6-14
16. Guarda LA, Ayala AG, Jaffe N, Sutow WW, Bracken RB. Chemotherapy induced histologic changes in Wilms' tumors. Pediat Pathol. 1984; 2:197-206
17. Jagt CT, Zuckermann M, Ten Kate F, Tamirniau JA, Dijkgraaf MG, Heij H, et al. Veno-occlusive disease as a complication of preoperative chemotherapy for Wilms tumor: A clinico-pathological analysis. Pediatr Blood Cancer. 2009; 53:1211-1215.
Published
2018-02-27
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