Gestational risk factors for Wilms' tumor: results of a case-control study

Gestational risk factors for Wilms' tumor were investigated in a pair-matched case-control study. Cases who were under 15 years of age at diagnosis during 1970-1983 were identified through the registries of the three main hospitals treating childhood cancer in the greater Philadelphia area. Controls were selected by random digit dialing and were matched to cases on race, birth date, and telephone area code and exchange. Because of a low participation rate among nonwhites, results are reported only for the 88 white matched pairs whose parents were interviewed by telephone. Of the hypothesized risk factors, maternal use of hair-coloring products in the year prior to the index child's birth (odds ratio, 3.6; P = 0.003) and hypertension or fluid retention during pregnancy (odds ratio, 5.0, P = 0.01) were significantly associated with increased risk of Wilms' tumor. Use of hair-coloring products was strongly associated with cases in which Wilms' tumor was diagnosed before 2 years of age (odds ratio, 15; P = 0.001). For two other gestational factors, tea drinking and vaginal infection, the odds ratios were significantly elevated for all cases and the effects were concentrated among the nongenetic cases. Bilateral cases had a significantly higher mean birth weight than did their controls. Older maternal age was significantly associated with the genetic form of Wilms' tumor. Adjustment for possible confounders and consideration of the time interval between the index pregnancy and the interview did not substantially alter the findings.

Neoplastic potential in patients with disorders of sexual differentiation

The occurrence of tumors was determined in 157 patients with disorders of sexual differentiation at a major pediatric hospital from 1960 to 1980. Gonadoblastoma developed in 2 of the 4 patients with mixed gonadal dysgenesis (MGD) who had not had bilateral gonadectomy; this indicates the need for early gonadectomy in such cases. Gonadal embryonal carcinoma developed in 1 child with Turner's syndrome (1 of 71). Four cases of nephroblastoma occurred, 1 in a child with MGD (1 of 18) and 3 in male pseudohermaphrodites (3 of 35). The nature of the defect linking male pseudohermaphroditism with Wilms tumor remains to be established.

Obstructive uropathy, renal dysplasia and nodular renal blastema: is there a relationship to Wilms tumor?

We report 3 cases of renal dysplasia related to congenital obstructive uropathy and associated with nodular renal blastema. The literature is reviewed in regard to this relationship, as well as the relationship of nodular renal blastema with Wilms tumor and Wilms tumor with congenital genitourinary anomalies. The possible implication of nodular renal blastema associated with dysplasia and obstructive uropathy is emphasized with respect to the risk of neoplastic change.

Nephroblastomatosis and Wilms' tumor. Clinical experience and management of seven patients

Nephroblastomatosis is an uncommon abnormality believed to represent the persistence of embryonal renal tissue. Its association with simultaneous or eventual Wilms' tumor has led to the speculation that it is a premalignant lesion. The accumulated clinical experience with this process and its progression to Wilms' tumor in three of seven individuals is discussed. It is concluded that conservative tissue sparing surgery, chemotherapy, and ultrasonographic follow-up are the approaches most appropriate for the management of these difficult patients.

Childhood cancer and occupational radiation exposure in parents

To test the hypothesis that a parent's job exposure to radiation affects his or her child's risk of cancer, the authors compared this exposure during the year before the child's birth for parents of children with and without cancer. Parents of children with cancer were no more likely to have worked in occupations, industries, or combined occupations and industries with potential ionizing radiation exposure. Bone cancer and Wilms' tumor occurred more frequently among children of fathers in all industries with moderate potential ionizing radiation exposure. Children with cancer more often had fathers who were aircraft mechanics (odds ratio (OR) = infinity, one-sided 95% lower limit = 1.5; P = 0.04). Although four of these six were military aircraft mechanics, only children whose fathers had military jobs with potential ionizing radiation exposure had an increased cancer risk (OR = 2.73; P = 0.01). Four cancer types occurred more often among children of fathers in specific radiation-related occupations: rhabdomyosarcoma among children whose fathers were petroleum industry foremen; retinoblastoma among children whose fathers were radio and television repairmen; central nervous system cancers and other lymphatic cancers among children of Air Force fathers. Because numbers of case fathers are small and confidence limits are broad, the associations identified by this study need to be confirmed in other studies. Better identification and gradation of occupational exposure to radiation would increase the sensitivity to detect associations.

Paternal occupation and Wilms' tumour in offspring

A case-control study was conducted to test the hypothesis that paternal occupation is a risk factor for Wilms' tumour in offspring. Occupations associated with exposure to lead (Pb) and to hydrocarbons were examined by computing odds ratios, all of which were greater than unity but not by a statistically significant margin. When painters were considered separately, children whose fathers had been so employed were six times more likely to develop Wilms' tumour than children whose fathers had other occupations. Like the results for the Pb and hydrocarbon related occupations, the estimated relative risk associated with painters did not reach statistical significance. Although these data require cautious interpretation because of the relatively small number of subjects, the results reported here are not wholly consistent with the results of the one previous study of paternal occupation and Wilms' tumour in offspring.

Renal pseudotumours caused by xanthogranulomatous pyelonephritis

Five cases of xanthogranulomatous pyelonephritis are described. Wilms's tumour was suspected preoperatively in 2 of the cases and a renal tumour appeared to be confirmed at laparotomy in three. Pathological examination is diagnostic and the condition appears to be always unilateral. Nephrectomy is curative.

Ectopic immature renal tissue over the dorsum of lumbar and sacral area in two infants

During reparative surgery for meningomyelocele of the lumbar area, a 7-week-old female infant was found to have a small, well-delineated, subcutaneous, renal blastema. A 3-month-old female infant was found to have immature renal tissue, consisting of glomeruli and tubules, in a soft tissue swelling dorsal to the sacrum. Neither of these patients showed neurologic or renal abnormalities. The second patient has had a disease-free follow-up period of six years. The possible etiology and significance of these benign findings and their relation to the origin of Wilms tumors are discussed.

[Nephroblastoma and Wilms' tumor in hemihypertrophy. Presentation and discussion of a case]

The authors describe the case of a young girl with hemihypertrophy who developed a Wilms tumour in a kidney affected by nephroblastomatosis. The history and clinical findings are presented together with the histological results. The relationship between the congenital abnormality (hemihypertrophy), the dysgenesis (nephroblastomatosis) and the tumour is discussed.

Pathology of chickens infected with avian nephoblastoma virus MAV-2(N)

A neophroblastoma-inducing myeloblastosis-associated virus, MAV-2(N), derived from avian myeloblastosis virus was characterized with respect to biochemical composition and avian pathogenesis. Purified fibroblast-grown virus contained the same size 35S ribonucleic acid and the same relative amounts of viral polypeptides as another myeloblastosis-associated virus inducing predominantly osteopetrosis MAV-2(O). Plaque-purified MAV-2(N) induced a 76 to 93% incidence of nephroblastoma and a 3 to 50% incidence of osteopetrosis in SPAFAS and line 15 x 7 chickens: the oncogenic spectrum and the onset of nephroblastoma varied with the line of chicken and the route of injection. Renal neoplasms were manifest in chickens older than 2 months and grew to a massive size. Furthermore, 29% of control chickens housed with MAV-2(N)-infected chickens demonstrated nephroblastoma. MAV-2(N)-infected chickens had growth rates and blood packed cell volumes comparable to those of uninfected chickens. Infected chickens 2 months of age had increased kidney, liver, and spleen weights; tumor-bearing chickens 3 to 4 months of age had increased liver, lung, brain, pancreas, and bone weights. The concentration of albumin was decreased and the concentration of gamma globulin was increased in the serum of MAV-2(N)-INFECTED CHICKENS. Analysis of the sera of nephroblastoma-bearing chickens for virus and antibody showed that three states existed: (i) high levels of neutralizing antibody, (ii) high levels of virus, and (iii) simultaneous presence of both at low levels. The pathological and virological features of MAV-2(N) which distinguish it from MAV-2(O) are discussed.

Persistent renal blastema (nephroblastomatosis) as a frequent precursor of Wilms' tumor; a pathological and clinical review. Part 2. Significance of nephroblastomatosis in the genesis of Wilms' tumor

The historical development of the concept of nephroblastomatosis is reviewed. Subtypes of nephroblastomatosis are described, and their interrelationships are discussed.

Occupations of fathers of patients with Wilms's tumour

A case-control study of 149 Connecticut-born children with Wilms's tumour reported to the Connecticut Tumor Registry during the period 1935--1973 and of 149 matched controls was undertaken in order to explore the possibility that children with Wilms's tumour may have been exposed perinatally to carcinogenic agents. The occupation of the father at the time of the child's birth was investigated and used as an indicator of potential sources of carcinogens to which infants in the study may have been exposed. An association was found between paternal occupations related to lead in the group developing Wilms's tumour compared with the controls.

Wilms' tumor--model of a curable pediatric malignant solid tumor

Wilms' tumor is the model of the treatment of a pediatric solid tumor. Initially it appeared that multi-modality therapy, consisting of transabodominal nephrectomy, post-operative radiation therapy to the tumor bed and adjuvant, single agent chemotherapy provided the highest likelihood of disease-free survival. The identification of important prognostic factors, such as histology, tumor weight, lymph node involvement and age at diagnosis has led to a re-examination of the treatment of Wilms' tumor. Future therapeutic developments will include the administration of less therapy to some well defined groups of patients, and the exploration of new programs for patients who have been demonstrated to have a poor prognosis using currently accepted treatment techniques.

Multifocal nephroblastic neoplasia

Among 23 patients with multifocal metanephric neoplasia were 14 patients with 43 grossly visible subcapsular tumorlets, 0.3-3.5 cm in diameter, that were apparently derived from nodular renal blastema. Tumorlets are defined as circumscribed lesions that are visible on the exterior surface of the kidney, produce either a raised nodule or, in a few instances, a shallow depression, and are independent of the main tumor(s). Most tumorlets displayed homogeneous epithelial maturation. A substantial minority of tumorlets retained a blastemic character and a few were histologically malignant. Tumorlets tended to be multiple and bilateral but were absent in 9 patients with multifocal disease, including 4 of 10 with bilateral tumors. About half the lesions that achieved tumorlet status, including those that gave rise to clinical tumors, underwent malignant transformation. Contralateral tumorlets should not be mistaken for metastasis and do not adversely affect prognosis. The incidence of neoplasia among young, close relatives of patients with multifocal disease appeared to be excessive, but no clear excess of major anomalies, hemihypertrophy, or minor genitourinary tract anomalies was revealed by a retrospective survey of hospital charts.

Extrauterine mesodermal (müllerian) adenosarcoma: a clinicopathologic analysis of five cases

Five extrauterine examples (three pelvic and two ovarian) of a distinctive mesodermal (müllerian) mixed tumor previously described to occur in the uterus and designated müllerian adenosarcoma are reported. The tumors were diagnosed during the fifth to eight decades of life. They usually formed very large, partly cystic masses, which had occasionally spread to adjacent organs by the time of operation. On microscopic examination the tumors consisted of benign-appearing neoplastic glands lying in a sarcomatous stroma. The glands were lined by a variety of müllerian epithelial cell types, and the stromal element resembled endometrial stromal sarcoma. Three patients had malignant courses manifested by intrabdominal recurrence, distant metastases, or both. This tumor should be clearly distinguished from the more common forms of mesodermal (müllerian) mixed tumor in which the epithilial as well as the stromal component is malignant and the prognosis is much more grave.

Müllerian adenosarcoma of the uterus: an ultrastructural study of four cases

Four cases of uterine müllerian adenosarcoma, a distinctive form of mixed müllerian tumor, were studied by light and electron microscopy. All tumors showed the characteristic histologic pattern of benign neoplastic glands within sarcomatous stroma. Ultrastructurally, both mesenchymal and epithelial cells were seen. The mesenchymal cells showed some features of endometrial stromal cells, including the presence of intracytoplasmic collagen fibers. The epithelial cells formed glands, which resembled benign endometrial glands and were separated from the stroma by a well-defined basal lamina. No transitional cells between the epithelial and mesenchymal cells were seen. The ultrastructural features of these tumors suggest that the sarcomatous portion is of endometrial stromal origin. The glandular portion may arise, along with the stroma, from multipotential stem cells, or the glands may be non-neoplastic entrapped endometrial glands stimulated by the stroma and thus appearing to form an integral part of the tumor.

Cystic partially differentiated nephroblastoma: a clinicopathologic entity in the spectrum of infantile renal neoplasia

Three cases of cystic partially differentiated nephroblastoma (CPDN) are presented and ten cases from literature are reviewed. CPDN has been designated by various terms; it is a cystic encapsulated tumor occurring before 2 years of age. Cysts are lined by epithelium; septa of the cysts show a mixture of partially differentiated and undifferentiated metanephrogenic blastema. This histologic feature distinguishes CPDN from multilocular cyst of kidney. In seven cases simple nephrectomy, and in remaining cases nephrectomy with radiation and/or chemotherapy, had been the treatment. The disease-free interval ranged from 5 to 72 months, without reports of recurrence or metastasis. CPDN appears to take a benign course and simple nephrectomy seems to be the treatemtn of choice. However, in view of the possibility of recurrence as shown in rare instances by congenital mesoblastic nephroma, another less aggressive lesion in the spectrum of infantile renal neoplasia, regular follow up is recommended.

[Problems of histogenesis and classification of nephroblastoma (Wilms' tumor) in children]

Nephroblastoma, a tumour of the kidney, is most often observed in children; it always includes the nephrogenous tissue in any variant of its differentiation. Histogenesis of this neoplasm is multiform and complex. Its development from very immature pluripotential (polypotent) cells (possibly, at the level of blastodermic vesicle) is not ruled out. The histological classification of nephroblastomas, offered by the author, is based on the principles of differentiation of the tumour tissue and on its histogenesis and opens new perspectives for further investigation of neoplasms and for clinico-anatomic collations.