Ultrastructure and histogenesis of the renal tumors of childhood: an overview

Aniridia, Wilms' tumor and human chromosome 11

Aniridia-a developmental abnormality of the eye in which the iris is apparently absent-has been shown to be genetically associated with Wilms' tumor (an embryonic nephroblastoma) in the WAGR syndrome. Genetic and cytogenetic evidence points to band p13 of human chromosome 11 as the localization of the genes responsible for these defects. Deleted chromosomes 11 from WAGR patients and clinically associated translocations involving 11p13 have been used to map and order genes and anonymous DNA markers around the WAGR locus refining the localization of the aniridia and Wilms' tumor genes to within about 1 million base pairs of DNA.

Extrarenal Wilms' tumor: an analysis of four cases

During a review of Wilms' tumor, four located external to the kidney were identified. Patient age ranged from 7 months to 4 years; three were female. One neoplasm was located in the parametrial connective tissue to the left of the uterus; both kidneys were radiographically normal. Three neoplasms were located in the right retroperitoneum adherent to the surface of the ipsilateral kidney, but separated from the parenchyma by a thick fibrous capsule. Two were attached to the upper pole, while the third was attached to the midportion of the kidney. Radiologic studies showed displacement of all three kidneys, but intravenous pyelogram (IVP) revealed no calyceal distortion. All four neoplasms were favorable histology Wilms' tumor: one was monophasic epithelial type, one was monophasic blastemal type, and two had a mixture of stromal, epithelial, and blastemal tissue. No teratomatous elements were present. Immunoperoxidase staining for cytokeratin (AE-1, AE-3, CAM 5.2), vimentin, and epithelial membrane antigen (EMA) showed the strongest focal positive staining of tubular structures with CAM 5.2, and slight staining with EMA. Staining reaction to vimentin was variable, but negative in most areas. Three tumors extracted from paraffin were diploid by quantitative flow cytometric DNA analysis; in one case, flow cytometry could not be performed. Clinical follow-up from 2 years to 6 years showed all children to be alive without evidence of disease. Based on the similarity to conventional renal Wilms' tumor, these findings support the hypothesis of displaced mesonephric/metanephric rests for the origin of extrarenal Wilms' tumor.

Aspiration cytology of Wilms' tumor: correlation of cytologic and histologic features

We examined the cytomorphologic features of fine-needle aspiration biopsy (FNAB) specimens from 23 Wilms' tumor patients. The findings were correlated with histopathologic patterns from these tumors. The study revealed a close resemblance between the cytologic and histopathologic appearance of various cellular elements in Wilms' tumors. The major cellular patterns seen in Wilms' tumor include blastemal cells, blastemal cells with epithelial differentiation, blastemal cells with tubular differentiation, and stromal elements. It is hoped that recognition of these cellular components in aspiration smears will be helpful in establishing an FNAB diagnosis of Wilms' tumor.

Loss of chromosome 11p alleles in cultured cells derived from Wilms' tumours

Cell cultures have been produced from five Wilms' tumours. All cultures had a finite lifespan and a pattern of antigen expression which indicated that the cells were derived from the differentiated components of the tumours. No cells showed any of the expected characteristics of the putative Wilms' tumour stem cell. Nevertheless, in both cases where the original tumours showed a loss of heterozygosity at chromosome 11p alleles, the cultured cells also demonstrated a loss of heterozygosity. Thus these cell cultures definitely originated from Wilms' tumour tissue. The results demonstrate that cell cultures can be produced from the differentiated tissues present in Wilms' tumours and that these non-immortal cells show no 'transformed' phenotype, even though they possess the genetic changes present in the original tumour.

Classical and cellular (atypical) congenital mesoblastic nephroma: a clinicopathologic, ultrastructural, immunohistochemical, and flow cytometric study

Sixteen cases of congenital mesoblastic nephroma (CMN) were studied. The tumors showed variable patterns of growth, degrees of cellularity, and mitotic activity. Six tumors had the classical pattern of CMN, seven were of the cellular or atypical variant and three showed combined features. The mean ages at presentation were 16 days, 5.3 months, and 2.3 months, respectively. Average size and weight were 5.1 cm and 94 g for classical CMN, 9.1 cm and 620 g for cellular CMN and 10.5 cm and 150 g for combined tumors. Cyst formation, hemorrhage and necrosis were confined to cellular CMNs and to cellular areas of combined CMNs. Mitotic activity ranged from 0 to 1/10 high-power fields (HPFs) in classical tumors to 25 to 30/10 HPFs in cellular tumors. Clear cell sarcoma-like areas were observed in three neoplasms. In ten cases there was invasion of perirenal fat; in one case each, invasion of the psoas muscle, renal vein wall, and renal vein lumen was observed. Ultrastructural and immunohistochemical studies showed features consistent with myofibroblastic differentiation. Flow cytometric analysis revealed euploidy in one classic CMN, one cellular CMN and in classic areas of a combined CMN; cellular areas of the latter tumor were aneuploid. All patients with follow-up were alive without evidence of disease after a mean period of 5 years following nephrectomy alone. No correlation was observed between the pathologic features assessed and the biologic behavior of these neoplasms.

Malignant rhabdoid tumour of the kidney expressing neurofilament proteins. Immunohistochemical findings and histogenetic aspects

A malignant rhabdoid tumour (MRT) of the kidney was studied immunohistochemically using a large panel of monoclonal antibodies. All tumour cells were marked by a vimentin antibody. Variable amounts of the tumour cells were stained by antibodies specific for neurofilament proteins. Keratin, desmin and GFA, however, were not expressed. Antibodies reacting with lymphohaematopoietic antigens as well as with normal renal tissue and renal neoplasms, especially Wilms' tumours, (BA-1, BA-2, BA-3) and an antibody directed against Tamm-Horsfall protein failed to stain the tumour. These results, especially the expression of neurofilaments demonstrated for the first time in a MRT, point to a derivation of the demonstrated tumour from the neural crest. Analysis of the heterogeneous immunohistological marker expression and of the different primary sites of MRTs suggest that these highly malignant neoplasms are a histogenetically heterogeneous group, irrespective of their characteristic light microscopic appearance.

Fine-needle aspiration biopsy of clear-cell sarcoma of the kidney: light and electron microscopic features

Smears from seven fine-needle aspiration biopsies from three patients with clear-cell sarcoma of the kidney were reviewed, and the findings were correlated with corresponding histopathologic appearances. In two cases, the tumor cells were polygonal to spindle-shaped and were loosely arranged in a matrix of mucoid material. The histopathologic examination of the resected tumors in these cases revealed a classic pattern. In the third case, the aspiration smears revealed round to polygonal cells with moderate to abundant cytoplasm but without the mucoid matrix. The predominant histologic appearance of this tumor was an epithelioid trabecular pattern. Electron microscopic findings were similar to those described in published studies.

Anaplastic Wilms' tumor and other clinically aggressive childhood renal neoplasms: ultrastructural and immunocytochemical features

The ultrastructural and immunocytochemical findings in a series of 32 rarely encountered childhood renal malignancies are reviewed. The discussion includes anaplastic Wilms' tumors, renal clear cell sarcomas, rhabdoid tumors, carcinomas, sarcomas, neuroendocrine tumors, and lymphomas. An attempt is made to assess the relative merits of these two techniques in the differential diagnosis of these often troublesome lesions.

A contemporary view of neoplasms in children. The pathologist's perspective

The diagnosis of childhood malignancy is a complex endeavor that requires the cooperation of the clinician and pathologist. On occasion, potentially problematic situations arise when a biopsy cannot answer all of the questions or is nondiagnostic. Delays may occur before a final diagnosis is possible in an especially complicated case that requires several time-consuming studies. The pathologist should appreciate the pressure placed on the clinician to initiate treatment and, in turn, the clinician should realize that several steps are necessary before the pathologic examination can be completed.

Establishment and characterization of an immature epithelial cell line (ENU-T-1) derived from a rat nephroblastoma

A new cell line designated ENU-T-1 has been established from a xenotransplanted experimental rat nephroblastoma. The cultured cells are spindle-shaped or polygonal and are arranged in a wavy fashion morphologically similar to cultured embryonal renal epithelial cells. The cells exhibit a number of epithelial characteristics. Enzyme histochemistry gives positive reactions for gamma-glutamyltranspeptidase and alkaline phosphatase, both of which are present in renal tubular epithelial cells. Immunofluorescence studies show positive reactions for vimentin and cytokeratin. When inoculated into athymic nude mice, the cultured cells form tumors composed of sheets of epithelial cells with focal tubular formation. This cell line may be of value in studying differentiation of nephroblastoma, and possibly normal nephrogenesis.

Evaluation of polysialic acid in the diagnosis of Wilms' tumor. A comparative study on urinary tract tumors and non-neuroendocrine tumors

The polysialic acid moiety of the neural cell adhesion molecule has been shown to represent an onco-developmental antigen which can be detected in both embryonic human kidney and Wilms' tumor but not in normal adult human kidney. In the present comparative study, Wilms' tumors, clear cell (bone-metastasizing) sarcomas of kidney, cystic nephromas, renal cell carcinomas, transitional cell carcinomas and papillomas of the renal pelvis, ureter and urinary bladder (as well normal transitional epithelium from these regions). Ewing sarcomas, hepatoblastomas, rhabdomyosarcomas, and carcinomas of the stomach, colon, exocrine pancreas, lung, and esophagus, were investigated immunohistochemically for the presence of polysialic acid. In addition, immunoblot analysis was performed in selected tumors. With the exception of Wilms' tumor, none of the tumors investigated was positive for polysialic acid. In Wilms' tumor, blastemal cells and all epithelial components were positive but no immunostaining was observed in the stroma. These observations emphasize the potential value of a monoclonal anti-polysialic acid antibody in identifying blastemal metanephric cells and their epithelial differentiatives in Wilms' tumor.