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Nasir AA, Abdur-Raheem NT, Abdur-Rahman LO, Ibiyeye TT, Sayomi TO, Adedoyin OT, Adeniran JO. Characteristics and Clinical Outcomes of Children With Wilms' Tumour: A 15-year Experience in a Single Centre in Nigeria. J Pediatr Surg 2024; 59:1009-1014. [PMID: 38184433 DOI: 10.1016/j.jpedsurg.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/03/2023] [Accepted: 12/09/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Wilms' tumor (WT) is the most common paediatric renal tumor and is one of the most treatment-responsive solid tumours. Survival from Wilms tumour (WT) in sub-Saharan Africa remains dismal as a result of late presentation, treatment abandonment and infrastructure deficit. The purpose of this study was to analyze the clinical outcome of children with Wilms tumour managed in a Nigerian referral centre over a 15-year period. METHODS This is a retrospective study of children with WT (nephroblastoma) who were treated at our institution between January 2006 and December 2020. Clinical characteristics, treatments, and outcomes were analyzed. RESULTS Thirty-five patients were identified. The median age at diagnosis was 36 months including 22 (62.9 %) females. Twenty-six (74.3 %) had advanced (stage III & IV) disease. Confirmatory histology was available for 16 patients ((45.7 %) among which 10 (62.5 %) were mixed type. The right kidney was affected in 18 patients (51.4 %), left in 15 (42.9 %) and 2 were not documented. Preoperative chemotherapy was given in 22 (62.9 %) patients and 13 (37.1) patients had primary nephrectomy. Eight (22.9 %) patients died during treatment (from disease or treatment related causes), and one abandoned treatment. A total of 26 patients completed treatment. Out of these, 8 (30.8 %) were lost to follow up, four patients died and 14 (53.8 %) patients survived at a median follow-up period of 18 months. The survival decreased with advancing stages of the disease, p = 0.002. CONCLUSIONS Majority of children with Wilms tumour in our practice presented with advanced disease. Death during treatment, treatment abandonment and lost to follow up were common. LEVEL OF EVIDENCE Level II. TYPE OF STUDY Retrospective Study.
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Affiliation(s)
- Abdulrasheed A Nasir
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | - Nurudeen T Abdur-Raheem
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Lukman O Abdur-Rahman
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Tolulope O Sayomi
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olanrewaju T Adedoyin
- Division of Nephrology, Department of Paediatric, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - James O Adeniran
- Division of Paediatric Surgery, Department of Surgery, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
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Hsiao W, Denburg M, Laskin B. Hypertension in Wilms tumor. Pediatr Nephrol 2024; 39:15-24. [PMID: 37178208 DOI: 10.1007/s00467-023-06011-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Wilms tumor (WT) represents over 90% of all pediatric kidney tumors. Children with WT often present acutely with hypertension which resolves in the short term after nephrectomy. However, WT survivors have increased long-term risk of hypertension, primarily due to decreased nephron mass after nephrectomy, with additional insults from possible exposure to abdominal radiation and nephrotoxic therapies. The diagnosis of hypertension may be improved by ambulatory blood pressure monitoring (ABPM), as several recent single-center studies have shown a substantial proportion of WT survivors with masked hypertension. Current gaps in knowledge include determining which WT patients may benefit from routine screening with ABPM, correlation of casual and ABPM parameters with cardiac abnormalities, and longitudinal assessment of cardiovascular and kidney parameters in relation to appropriate treatment of hypertension. This review aims to summarize the most recent literature on hypertension presentation and management at the time of WT diagnosis as well as the long-term hypertension risk and impact on kidney and cardiovascular outcomes in WT survivors.
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Affiliation(s)
- Wendy Hsiao
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Michelle Denburg
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin Laskin
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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3
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Ekuk E, Odongo CN, Tibaijuka L, Oyania F, Egesa WI, Bongomin F, Atwiine R, Acan M, Situma M. One year overall survival of wilms tumor cases and its predictors, among children diagnosed at a teaching hospital in South Western Uganda: a retrospective cohort study. BMC Cancer 2023; 23:196. [PMID: 36864435 PMCID: PMC9979450 DOI: 10.1186/s12885-023-10601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Wilms tumor (WT) is the second most common solid tumor in Africa with both low overall survival (OS) and event-free survival (EFS) rates. However, no known factors are predicting this poor overall survival. OBJECTIVE The study was to determine the one-year overall survival of WT cases and its predictors among children diagnosed in the pediatric oncology and surgical units of Mbarara regional referral hospital (MRRH), western Uganda. METHODOLOGY Children's treatment charts and files diagnosed and managed for WT were retrospectively followed up for the period between January 2017 to January 2021. Charts of children with histologically confirmed diagnoses were reviewed for demographics, clinical and histological characteristics, as well as treatment modalities. RESULTS One-year overall survival was found to be 59.3% (95% CI: 40.7-73.3), with tumor size greater than 15 cm (p 0.021) and unfavorable WT type (p 0.012) being the predominant predictors. CONCLUSION Overall survival (OS) of WT at MRRH was found to be 59.3%, and predictive factors noted were unfavorable histology and tumor size greater than 115 cm.
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Affiliation(s)
- Eddymond Ekuk
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda.
| | - Charles Newton Odongo
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda.,Department of Anatomy, Faculty of Medicine Soroti University, Soroti, Uganda
| | - Leevan Tibaijuka
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Felix Oyania
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Walufu Ivan Egesa
- Department of Pediatrics, Faculty of Clinical Medicine and Dentistry, Kampala International, Kampala, Uganda
| | - Felix Bongomin
- Department of Microbiology, Mycology, and Immunology, Internal Medicine Gulu University, Gulu, Uganda
| | - Raymond Atwiine
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Moses Acan
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
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4
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Huang Y, Zhang W, Song H, Sun N, Han W. Dilated hypertensive cardiomyopathy in an infant with unilateral Wilms tumor: A case report and literature review. Pediatr Blood Cancer 2023; 70:e29963. [PMID: 36527374 DOI: 10.1002/pbc.29963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Yangyue Huang
- Department of Pediatric Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Weiping Zhang
- Department of Pediatric Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Hongcheng Song
- Department of Pediatric Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Ning Sun
- Department of Pediatric Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Wenwen Han
- Department of Pediatric Urology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
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5
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Smriti V, Baheti AD, Shah S, Qureshi SS, Shetty N, Gala K, Kulkarni S, Raut A, Kamble V, Chinnaswamy G, Prasad M, C. P B, Ramadwar M, Singh S, Shukla A, Panwala H, Sahu A, Siddharth L, Kapadia T. Imaging Recommendations for Diagnosis, Staging, and Management of Pediatric Solid Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractPaediatric extra-cranial solid tumours are one of the common causes for paediatric malignancies. Lack of appropriate imaging at presentation, staging and for follow-up is a major challenge for paediatric solid tumours. We have reviewed the paediatric solid tumour imaging protocols suggested by the major oncological societies/groups around the world (mainly the SIOP – Society International Pediatric Oncology, and the COG – Children's Oncology Group). We have adapted some of those protocols to develop imaging recommendations for the diagnosis, staging and management of extra-cranial solid tumours based on the treatment protocols followed in India.
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Affiliation(s)
- Vasundhara Smriti
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Akshay D. Baheti
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and molecular imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sajid S. Qureshi
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nanadan Shetty
- Department of Opthalmology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Intervention Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Intervention Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhijit Raut
- Department of Radiodiagnosis, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Veenita Kamble
- Department of Radiodiagnosis, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Maya Prasad
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Badira C. P
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suryaveer Singh
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuradha Shukla
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hirenkumar Panwala
- Department of Radiodiagnosis, SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Arpita Sahu
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Laskar Siddharth
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tejas Kapadia
- Children's X-ray Department/Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, United Kingdom
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6
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Qu YN, Wu YR, Qu D, Ge HY. Extrarenal Wilms tumor with hypertension and dilated cardiomyopathy in an infant: A report of an unusual case. Pediatr Blood Cancer 2022; 69:e29900. [PMID: 35920589 DOI: 10.1002/pbc.29900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022]
Abstract
While Wilms tumors are the most frequently detected kidney cancer type in children, extrarenal Wilms tumors (ERWTs) remain rare. This report is the first to describe hypertension and dilated cardiomyopathy in a patient with an ERWT. A 6-month-old male infant presented with an abdominal mass and paroxysmal hypertension; echocardiography revealed dilated cardiomyopathy with an ejection fraction of 34%, as well as substantially increased plasma renin activity. Pathology yielded a definitive diagnosis of ERWT. Cardiac function and blood pressure gradually returned to normal after tumorectomy. The early diagnosis of such a tumor together with efficient oncologic treatment are vital to optimal patient outcomes.
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Affiliation(s)
- Yan-Ning Qu
- Department of Intensive Care Unit, Capital Institute of Pediatric Children's Hospital, Beijing, China
| | - Yu-Rui Wu
- Department of Thoracic and Oncological Surgery, Capital Institute of Pediatric Children's Hospital, Beijing, China
| | - Dong Qu
- Department of Intensive Care Unit, Capital Institute of Pediatric Children's Hospital, Beijing, China
| | - Hai-Yan Ge
- Department of Intensive Care Unit, Capital Institute of Pediatric Children's Hospital, Beijing, China
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7
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Steur A, Raymakers-Janssen PAMA, Kneyber MCJ, Dijkstra S, van Woensel JBM, van Waardenburg DA, van de Ven CP, van der Steeg AFW, Wijnen M, Lilien MR, de Krijger RR, van Tinteren H, Littooij AS, Janssens GO, Peek AML, Tytgat GAM, Mavinkurve-Groothuis AM, van Grotel M, van den Heuvel-Eibrink MM, Asperen RMWV. Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy. Cancers (Basel) 2022; 14:cancers14040943. [PMID: 35205701 PMCID: PMC8870004 DOI: 10.3390/cancers14040943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Survival of children with Wilms tumor is excellent. However, treatment-related complications may occur, requiring treatment at the pediatric intensive care unit (PICU). The aim of our retrospective study was to assess the frequency, clinical characteristics, and outcome of 175 children with Wilms tumor requiring treatment at the PICU in the Netherlands. Thirty-three patients (almost 20%) required unplanned PICU admission during their disease course. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were risk factors for these unplanned PICU admissions. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge. Two children died during their PICU stay. During follow up, hypertension and renal dysfunction were frequently observed, which justifies special attention for kidney function and blood pressure monitoring during and after treatment of these children. Abstract Survival rates are excellent for children with Wilms tumor (WT), yet tumor and treatment-related complications may require pediatric intensive care unit (PICU) admission. We assessed the frequency, clinical characteristics, and outcome of children with WT requiring PICU admissions in a multicenter, retrospective study in the Netherlands. Admission reasons of unplanned PICU admissions were described in relation to treatment phase. Unplanned PICU admissions were compared to a control group of no or planned PICU admissions, with regard to patient characteristics and short and long term outcomes. In a multicenter cohort of 175 children with an underlying WT, 50 unplanned PICU admissions were registered in 33 patients. Reasons for admission were diverse and varied per treatment phase. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were observed in children with unplanned PICU admission versus the other WT patients. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge (both with bilateral disease). Two children died during their PICU stay. During follow-up, hypertension and chronic kidney disease (18.2 vs. 4.2% and 15.2 vs. 0.7%) were more frequently observed in unplanned PICU admitted patients compared to the other patients. No significant differences in cardiac morbidity, relapse, or progression were observed. Almost 20% of children with WT required unplanned PICU admission, with young age and treatment intensity as potential risk factors. Hypertension and renal impairment were frequently observed in these patients, warranting special attention at presentation and during treatment and follow-up.
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Affiliation(s)
- Anouk Steur
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Paulien A. M. A. Raymakers-Janssen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
| | - Martin C. J. Kneyber
- Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital/University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.C.J.K.); (S.D.)
| | - Sandra Dijkstra
- Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital/University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.C.J.K.); (S.D.)
| | - Job B. M. van Woensel
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | - Dick A. van Waardenburg
- Department of Pediatric Intensive Care, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Cornelis P. van de Ven
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Alida F. W. van der Steeg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marc Wijnen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marc R. Lilien
- Department of Pediatric Nephrology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annemieke S. Littooij
- Department of Radiology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands;
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annemarie M. L. Peek
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Godelieve A. M. Tytgat
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annelies M. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Martine van Grotel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Roelie M. Wösten-van Asperen
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
- Correspondence:
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8
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van Peer SE, Hol JA, van der Steeg AFW, van Grotel M, Tytgat GAM, Mavinkurve-Groothuis AMC, Janssens GOR, Littooij AS, de Krijger RR, Jongmans MCJ, Lilien MR, Drost J, Kuiper RP, van Tinteren H, Wijnen MHWA, van den Heuvel-Eibrink MM. Bilateral Renal Tumors in Children: The First 5 Years' Experience of National Centralization in The Netherlands and a Narrative Review of the Literature. J Clin Med 2021; 10:jcm10235558. [PMID: 34884260 PMCID: PMC8658527 DOI: 10.3390/jcm10235558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
Survival of unilateral Wilms tumors (WTs) is exceeding 90%, whereas bilateral WTs have an inferior outcome. We evaluated all Dutch patients with bilateral kidney tumors, treated in the first five years of national centralization and reviewed relevant literature. We identified 24 patients in our center (2015–2020), 23 patients had WT/nephroblastomatosis and one renal cell carcinoma. Patients were treated according to SIOP-RTSG protocols. Chemotherapy response was observed in 26/34 WTs. Nephroblastomatosis lesions were stable (n = 7) or showed response (n = 18). Nephron-sparing surgery was performed in 11/22 patients undergoing surgery (n = 2 kidneys positive margins). Local stage in 20 patients with ≥1 WT revealed stage I (n = 7), II (n = 4) and III (n = 9). Histology was intermediate risk in 15 patients and high risk in 5. Three patients developed a WT in a treated nephroblastomatosis lesion. Two of 24 patients died following toxicity and renal failure, i.e., respectively dialysis-related invasive fungal infection and septic shock. Genetic predisposition was confirmed in 18/24 patients. Our literature review revealed that knowledge is scarce on bilateral renal tumor patients with metastases and that radiotherapy seems important for local stage III patients. Bilateral renal tumors are a therapeutic challenge. We describe management and outcome in a national expert center and summarized available literature, serving as baseline for further improvement of care.
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Affiliation(s)
- Sophie E. van Peer
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Correspondence:
| | - Janna A. Hol
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Alida F. W. van der Steeg
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Martine van Grotel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Godelieve A. M. Tytgat
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Geert O. R. Janssens
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Radiation Oncology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Annemieke S. Littooij
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Radiology and Nuclear Medicine, Wilhelmina’s Children Hospital, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ronald R. de Krijger
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Pathology, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marjolijn C. J. Jongmans
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Genetics, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marc R. Lilien
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Pediatric Nephrology, Wilhelmina’s Children Hospital, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jarno Drost
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Oncode Institute, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands
| | - Roland P. Kuiper
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
- Department of Genetics, University Medical Center Utrecht (UMCU), Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Harm van Tinteren
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Marc H. W. A. Wijnen
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
| | - Marry M. van den Heuvel-Eibrink
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (J.A.H.); (A.F.W.v.d.S.); (M.v.G.); (G.A.M.T.); (A.M.C.M.-G.); (G.O.R.J.); (A.S.L.); (R.R.d.K.); (M.C.J.J.); (M.R.L.); (J.D.); (R.P.K.); (H.v.T.); (M.H.W.A.W.); (M.M.v.d.H.-E.)
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9
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Ahmad N, Khan AH, Alomari A, Eltawel M. Wilms tumor – State of affairs in Riyadh, Saudi Arabia. A retrospective review over 15 years from a single center. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Balis F, Green DM, Anderson C, Cook S, Dhillon J, Gow K, Hiniker S, Jasty-Rao R, Lin C, Lovvorn H, MacEwan I, Martinez-Agosto J, Mullen E, Murphy ES, Ranalli M, Rhee D, Rokitka D, Tracy EL, Vern-Gross T, Walsh MF, Walz A, Wickiser J, Zapala M, Berardi RA, Hughes M. Wilms Tumor (Nephroblastoma), Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:945-977. [PMID: 34416707 DOI: 10.6004/jnccn.2021.0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Wilms Tumor focus on the screening, diagnosis, staging, treatment, and management of Wilms tumor (WT, also known as nephroblastoma). WT is the most common primary renal tumor in children. Five-year survival is more than 90% for children with all stages of favorable histology WT who receive appropriate treatment. All patients with WT should be managed by a multidisciplinary team with experience in managing renal tumors; consulting a pediatric oncologist is strongly encouraged. Treatment of WT includes surgery, neoadjuvant or adjuvant chemotherapy, and radiation therapy (RT) if needed. Careful use of available therapies is necessary to maximize cure and minimize long-term toxicities. This article discusses the NCCN Guidelines recommendations for favorable histology WT.
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Affiliation(s)
- Frank Balis
- Abramson Cancer Center at the University of Pennsylvania
| | - Daniel M Green
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Shelly Cook
- University of Wisconsin Carbone Cancer Center
| | | | - Kenneth Gow
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Chi Lin
- Fred & Pamela Buffett Cancer Center
| | | | | | | | | | - Erin S Murphy
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Mark Ranalli
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Rhee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Amy Walz
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Matthew Zapala
- UCSF Helen Diller Family Comprehensive Cancer Center; and
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11
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Congestive heart failure and hypertension associated with Wilms tumor. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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de Paula Gonzaga ALAC, Palmeira VA, Ribeiro TFS, Costa LB, de Sá Rodrigues KE, Simões-E-Silva AC. ACE2/Angiotensin-(1-7)/Mas Receptor Axis in Human Cancer: Potential Role for Pediatric Tumors. Curr Drug Targets 2021; 21:892-901. [PMID: 32039680 DOI: 10.2174/1389450121666200210124217] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pediatric tumors remain the highest cause of death in developed countries. Research on novel therapeutic strategies with lesser side effects is of utmost importance. In this scenario, the role of Renin-Angiotensin System (RAS) axes, the classical one formed by angiotensinconverting enzyme (ACE), Angiotensin II and AT1 receptor and the alternative axis composed by ACE2, Angiotensin-(1-7) and Mas receptor, have been investigated in cancer. OBJECTIVE This review aimed to summarize the pathophysiological role of RAS in cancer, evidence for anti-tumor effects of ACE2/Angiotensin-(1-7)/Mas receptor axis and future therapeutic perspectives for pediatric cancer. METHODS Pubmed, Scopus and Scielo were searched in regard to RAS molecules in human cancer and pediatric patients. The search terms were "RAS", "ACE", "Angiotensin-(1-7)", "ACE2", "Angiotensin II", "AT1 receptor", "Mas receptor", "Pediatric", "Cancer". RESULTS Experimental studies have shown that Angiotensin-(1-7) inhibits the growth of tumor cells and reduces local inflammation and angiogenesis in several types of cancer. Clinical trials with Angiotensin-( 1-7) or TXA127, a pharmaceutical grade formulation of the naturally occurring peptide, have reported promising findings, but not enough to recommend medical use in human cancer. In regard to pediatric cancer, only three articles that marginally investigated RAS components were found and none of them evaluated molecules of the alternative RAS axis. CONCLUSION Despite the potential applicability of Angiotensin-(1-7) in pediatric tumors, the role of this molecule was never tested. Further clinical trials are necessary, also including pediatric patients, to confirm safety and efficiency and to define therapeutic targets.
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Affiliation(s)
| | - Vitória Andrade Palmeira
- Pediatric Branch, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Brazil
| | | | - Larissa Braga Costa
- Pediatric Branch, Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, UFMG, Brazil
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13
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Kuwabara J, Akita S, Sato M, Watanabe K, Kawamoto T, Tanigawa K, Matsui S, Matsuno Y, Abe Y, Kikuchi S, Yoshida M, Koga S, Ishimaru K, Egi H, Watanabe Y. Hypertensive Cardiomyopathy with Congestive Heart Failure in an Infant with Unilateral Wilms Tumor: A Case Report. J NIPPON MED SCH 2020; 88:551-555. [PMID: 33250480 DOI: 10.1272/jnms.jnms.2021_88-513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Wilms tumor (WT) is the most common malignant kidney tumor in children. High blood pressure is seen in up to 55% of children with WT. However, hypertensive cardiomyopathy with congestive heart failure due to WT is remarkably rare, with only several cases reported worldwide. In this report, a pediatric case of WT with hypertension causing hypertensive cardiomyopathy and congestive heart failure is presented. An 8-month-old male child with abdominal distension was seen by his primary physician. He was referred to our hospital for further examination and treatment. Abdominal contrast-enhanced computed tomography demonstrated a weakly enhancing, large abdominal mass, which was larger than 12 cm. Two-dimensional transthoracic echocardiography showed a diffuse hypokinetic left ventricle. The patient was diagnosed with cardiomyopathy caused by hypertension. Open surgical resection of the mass was successfully performed. His postoperative course was uncomplicated, and the patient was successfully discharged. The plasma renin activity was maintained at a high level even after left nephrectomy, suggesting that the right kidney was likely the source of renin secretion. Mechanical compression of the right renal blood vessels by a greatly enlarged left kidney can cause right renal ischemia, which activates renin excretion. Nephrectomy can be an effective treatment for a WT patient with hypertension causing hypertensive cardiomyopathy, and then cardiac function will be improved within several weeks. We recommend routine echocardiography surveillance in patients with WT. This report can help pediatric surgeons become more familiar with cardiomyopathy caused by WT.
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Affiliation(s)
- Jun Kuwabara
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Satoshi Akita
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Mitsunori Sato
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Katsuya Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Takayasu Kawamoto
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Kazufumi Tanigawa
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Sayuri Matsui
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | | | - Yousuke Abe
- Department of Surgery, Saijo Central Hospital
| | - Satoshi Kikuchi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Motohira Yoshida
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Shigehiro Koga
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Kei Ishimaru
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Hiroyuki Egi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
| | - Yuji Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine
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14
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Burdman I, Burckhardt BB. Prorenin and active renin levels in paediatrics: a bioanalytical review. Clin Chem Lab Med 2020; 59:275-285. [PMID: 32813674 DOI: 10.1515/cclm-2020-0857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/30/2020] [Indexed: 11/15/2022]
Abstract
As part of the extended renin-angiotensin-aldosterone system, active renin and its precursor prorenin have been an area of research interest for decades. Although several studies showed a correlation with disease, other studies found no significant association, e.g. attributed to limited sample size or pharmacological effects of antihypertensive drugs. Since the measurement of both proteins has typically been carried out in adult populations, the data in paediatrics is limited. This review aimed to collate the current data on plasma renin and prorenin levels in children and compare the levels of healthy vs. the diseased state. A literature search using Medline resulted in 213 publications of which 15 studies were classified as relevant. In the extant studies in the literature, an age-dependent decline of renin plasma concentration was observed in newborns compared to adolescents. For children with cardiovascular disease, five studies were identified that provide limited insight into the pathophysiological regulation of renin. In general, sample handling is still a crucial step, which might particularly affect measured active renin concentrations due to conformational changes of its precursor prorenin. A reliable assessment for prorenin levels in the maturating population is yet not possible due to the low number of available publications. Three different approaches to quantify prorenin were found and raise the question on the comparability of these methods. The review emphazised several weaknesses and highlights the need for an accurate procedure to determine levels of active renin as well as prorenin in its closed and open form.
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Affiliation(s)
- Ilja Burdman
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Dusseldorf, Germany
| | - Bjoern B Burckhardt
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich-Heine-University, Dusseldorf, Germany
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15
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Sethasathien S, Choed-Amphai C, Saengsin K, Sathitsamitphong L, Charoenkwan P, Tepmalai K, Silvilairat S. Wilms tumor with dilated cardiomyopathy: A case report. World J Clin Oncol 2019; 10:293-299. [PMID: 31528545 PMCID: PMC6717704 DOI: 10.5306/wjco.v10.i8.293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Wilms tumor is the most common renal malignancy in childhood. It occurs primarily between the ages of 2 and 5 years. The usual manifestations are abdominal mass, hypertension, and hematuria. The case presented here had an unusual presentation, with dilated cardiomyopathy and hypertension secondary to the Wilms tumor.
CASE SUMMARY A 3-year-old boy presented with a 5-d history of irritability, poor appetite, and respiratory distress. His presenting clinical symptoms were dyspnea, tachycardia, hypertension, and a palpable abdominal mass at the left upper quadrant. His troponin T and pro-B-type natriuretic peptide levels were elevated. Echocardiography demonstrated a dilated hypokinetic left ventricle with an ejection fraction of 29%, and a suspected left renal mass. Computed tomography scan revealed a left renal mass and multiple lung nodules. The definitive diagnosis of Wilms tumor was confirmed histologically. The patient was administered neoadjuvant chemotherapy and underwent radical nephrectomy. After surgery, radiotherapy was administered, and the adjuvant chemotherapy was continued. The blood pressure and left ventricular function normalized after the treatments.
CONCLUSION Abdominal mass, dilated cardiomyopathy and hypertension can indicate Wilms tumor in pediatric patients. Chemotherapy and tumor removal achieve successful treatment.
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Affiliation(s)
- Saviga Sethasathien
- Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chane Choed-Amphai
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kwannapas Saengsin
- Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Lalita Sathitsamitphong
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pimlak Charoenkwan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kanokkan Tepmalai
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suchaya Silvilairat
- Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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16
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Probst PJ, Assadi A, Gleason J. Botryoid Wilms Tumor: A Rare Diagnosis With an Atypical Presentation. Urology 2019; 126:192-194. [PMID: 30735745 DOI: 10.1016/j.urology.2019.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/15/2022]
Abstract
Wilms tumor commonly presents as an asymptomatic abdominal mass. In some cases, it can be accompanied with hypertension, constitutional symptoms, and hematuria when involving the collecting system. Below, we review the case of a child diagnosed with botryoid Wilms tumor involving the upper calyces and renal pelvis in which the presenting symptom was a concern for a foreign body in her left ear, and the only abnormality during initial history and physical examination was stage II hypertension.
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Affiliation(s)
- Patrick J Probst
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, LeBonheur Children's Hospital, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Akram Assadi
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, LeBonheur Children's Hospital, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN
| | - Joseph Gleason
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, LeBonheur Children's Hospital, Memphis, TN; Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
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17
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Mouat IC, Omata K, McDaniel AS, Hattangady NG, Talapatra D, Cani AK, Hovelson DH, Tomlins SA, Rainey WE, Hammer GD, Giordano TJ, Else T. Somatic mutations in adrenocortical carcinoma with primary aldosteronism or hyperreninemic hyperaldosteronism. Endocr Relat Cancer 2019; 26:217-225. [PMID: 30475217 PMCID: PMC7065382 DOI: 10.1530/erc-18-0385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/19/2018] [Indexed: 02/03/2023]
Abstract
Several somatic mutations specific to aldosterone-producing adenomas (APAs) have been described. A small proportion of adrenocortical carcinomas (ACCs) are associated with hyperaldosteronism, either primary aldosteronism or hyperreninemic hyperaldosteronism. However, it is unknown whether they harbor mutations of the same spectrum as APAs. The objective of this study is to describe the clinical phenotype and molecular genotype of ACCs with hyperaldosteronism, particularly the analysis for common APA-associated genetic changes. Patients were identified by retrospective chart review at a specialized referral center and by positive staining for CYP11B2 of tissue microarrays. Twenty-five patients with ACC and hyperaldosteronism were initially identified by retrospective chart review, and tissue for further analysis was available on 13 tumors. Seven patients were identified by positive staining for CYP11B2 in a tissue microarray, of which two were already identified in the initial chart review. Therefore, a total number of 18 patients with a diagnosis of ACC and features of either primary aldosteronism or hyperreninemic hyperaldosteronism were therefore included in the final study. Mutational status for a select list of oncogenes, tumor suppressor genes and genes known to carry mutations in APAs were analyzed by next-generation sequencing. Review of clinical data suggested autonomous aldosterone production in the majority of cases, while for some cases, hyperreninemic hyperaldosteronism was the more likely mechanism. The mutational landscape of ACCs associated with hyperaldosteronism was not different from ACCs with a different hormonal phenotype. None of the ACCs harbored mutations of known APA-associated genes, suggesting an alternative mechanism conferring aldosterone production.
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Affiliation(s)
- Isobel C Mouat
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kei Omata
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Andrew S McDaniel
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Namita G Hattangady
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Debnita Talapatra
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Andi K Cani
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Daniel H Hovelson
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott A Tomlins
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Michigan Center for Translational Pathology, Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - William E Rainey
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Gary D Hammer
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Thomas J Giordano
- Department of Pathology, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Tobias Else
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Comprehensive Cancer Center, University of Michigan Medical School, Ann Arbor, Michigan, USA
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18
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Gold SA, Sabarwal VK, Gordhan C, Hale GR, Winer A. Lymph node imaging of pediatric renal and suprarenal malignancies. Transl Androl Urol 2018; 7:774-782. [PMID: 30456181 PMCID: PMC6212619 DOI: 10.21037/tau.2018.07.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pediatric renal and suprarenal cancers are relatively rare malignancies, but are not without significant consequence to both the patient and caretakers. These tumors are often found incidentally and present as large abdominal masses. Standard of care management involves surgical excision of the mass, but contemporary treatment guidelines advocate for use of neoadjuvant or adjuvant chemotherapy for advanced stage disease, such as those cases with lymph node involvement (LNI). However, LNI detection is based primarily on surgical pathology and performing extended lymph node dissection can add significant morbidity to a surgical case. In this review, we focus on the use and performance of imaging modalities to detect LNI in Wilms’ tumor (WT), neuroblastoma, and pediatric renal cell carcinoma (RCC). We report on how imaging impacts management of these cases and the clinical implications of LNI. A literature search was conducted for studies published on imaging-based detection of LNI in pediatric renal and suprarenal cancers. Further review focused on surgical and medical management of those cases with suspected LNI. Current imaging protocols assisting in diagnosis and staging of pediatric renal and suprarenal cancers are generally limited to abdominal ultrasound and cross-sectional imaging, mainly computed tomography (CT). Recent research has investigated the role of more advance modalities, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), in the management of these malignancies. Special consideration must be made for pediatric patients who are more vulnerable to ionizing radiation and have characteristic imaging features different from adult controls. Management of pediatric renal and suprarenal cancers is influenced by LNI, but the rarity of these conditions has limited the volume of clinical research regarding imaging-based staging. As such, standardized criteria for LNI on imaging are lacking. Nevertheless, advanced imaging modalities are being investigated and potentially represent more accurate and safer options.
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Affiliation(s)
- Samuel A Gold
- SUNY Downstate College of Medicine, Downstate Medical Center, Brooklyn, NY, USA
| | - Vikram K Sabarwal
- Department of Urology, George Washington University Hospital, Washington, DC, USA
| | - Chirag Gordhan
- Department of Urology, George Washington University Hospital, Washington, DC, USA
| | - Graham R Hale
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, NY, USA
| | - Andrew Winer
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY, USA
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19
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Jastaniah W, Elimam N, Alluhaibi RS, Alharbi AT, Abbas AA, Abrar MB. The prognostic significance of hypertension at diagnosis in children with wilms tumor. Saudi Med J 2017; 38:262-267. [PMID: 28251221 PMCID: PMC5387902 DOI: 10.15537/smj.2017.3.15991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To determine the prognostic effect of hypertension at diagnosis on outcomes of children with Wilms tumor (WT). Methods: A single center retrospective analysis was conducted on 85 consecutive children with WT diagnosed between January 2000 and August 2013. Patients were classified as hypertensive or normotensive at diagnosis. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Cox regression was used to determine the predictive significance of hypertension and other clinical factors. Results: Seventy-one patients had complete data. Of this, 25 (35.2%) were hypertensive and 46 (64.8%) normotensive with corresponding remission rates of 56.0% versus 82.6%, p=0.032; and death as first event of 7% versus 0%, p=0.004. The 5-year OS in the hypertensive versus normotensive patients were (67.1±10.3% versus 89.6±4.9%, p=0.009) and the corresponding 5-year PFS were (53.4±10.4% versus 79.1±6.2%, p=0.007). With univariate analysis, hypertension and local stage were predictors of OS (p=0.012 and p=0.029) and PFS (p=0.030 and p=0.008). In the multivariate analysis, hypertension, local stage, and histopathology were identified as independent prognostic factors of OS (p=0.004, p=0.034, and p=0.038); and hypertension and local stage as prognostic for PFS (p=0.010 and p=0.012). Conclusion: Hypertension at diagnosis is a prognostic predictor of poor outcome in WT and may signify tumor resistance.
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Affiliation(s)
- Wasil Jastaniah
- Princess Noorah Oncology Center, King Abdulaziz Medical City, Jeddah, Kingdom of Saudi Arabia. E-mai.
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20
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Nguyen R, Wilson MW, Fernandez-Pineda I, Brennan RC, Furman WL. Two-Year-Old Boy With Leukocoria and Strabismus. Clin Pediatr (Phila) 2016; 55:1187-9. [PMID: 26531178 DOI: 10.1177/0009922815614360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rosa Nguyen
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Matthew W Wilson
- St Jude Children's Research Hospital, Memphis, TN, USA Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
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21
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Provenzi VO, Rosa RFM, Rosa RCM, Roehe AV, dos Santos PPA, Faulhaber FRS, de Oliveira CAV, Zen PRG. Wilms tumor: experience of a hospital in southern Brazil. Pediatr Int 2014; 56:534-40. [PMID: 24447407 DOI: 10.1111/ped.12295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 09/25/2013] [Accepted: 12/26/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wilms tumor (WT) is the most common renal malignancy of childhood. The aim of this study was to verify the epidemiological profile and prognosis of a sample of patients from Brazil and compare them to similar data from other Latin American studies. METHOD The sample consisted of consecutive patients diagnosed with WT in an oncohematology service of a referral hospital in Southern Brazil, between 1989 and 2009. Clinical, radiological, pathological and survival data were collected from the medical records. Analysis was done using Excel and SPSS version 18.0. The significance level was set at P < 0.05. RESULTS The final sample consisted of 45 patients. The male/female ratio was 1.25:1. Mean age at diagnosis was 43.9 months and all patients were of European descent. Thirty-three patients (73.3%) had both signs/symptoms of abdominal mass and hypertension. Malformation was observed in nine patients (20%) and there was one case of Fanconi's anemia (2.2%). Three patients had bilateral disease (6.7%). The majority of patients had stage III and IV (62.2%). Patients with malformation had an earlier age at diagnosis (P = 0.018) and a higher prevalence of bilateral disease (P = 0.044). Overall survival was 75%. Age at diagnosis was the only significant independent predictor associated with death. CONCLUSION Death is closely related to late diagnosis in WT. Oncologic services should also be concerned about morbidity caused by therapeutic options in cases of late diagnosis, and the consequences for quality of life.
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22
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Sanchez TR, Ducore J, Balagtas J, Molloy C, Wootton-Gorges SL. WARM N COLD: malignant and benign renal tumors in children. Emerg Radiol 2014; 21:261-9. [PMID: 24570120 DOI: 10.1007/s10140-014-1202-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/04/2014] [Indexed: 12/22/2022]
Abstract
Although Wilms tumor is the most common renal malignancy in children, the differential diagnosis is extensive and includes both malignant and benign disorders. We present a simple mnemonic-WARM N COLD, to aid in remembering these diverse tumors. Imaging clues including age of the patient, associated disease or syndrome as well as salient imaging characteristics such as bilaterality, and type or presence of metastasis are also presented and can help differentiate between these renal tumors of childhood.
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Affiliation(s)
- Thomas Ray Sanchez
- Division of Pediatric Radiology, Davis Children's Hospital, University of California, Sacramento, CA, USA,
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23
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Aronson DC, Maharaj A, Sheik-Gafoor MH, Hadley GP. The results of treatment of children with metastatic Wilms tumours (WT) in an African setting: do liver metastases have a negative impact on survival? Pediatr Blood Cancer 2012; 59:391-4. [PMID: 22315136 DOI: 10.1002/pbc.24080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 12/27/2011] [Indexed: 01/07/2023]
Abstract
BACKGROUND From Africa, where socio-economic circumstances differ from the developed world, there are no data regarding the influence of liver metastases on survival of children with Wilms tumour. PROCEDURE One hundred fifty new patients with WT were seen between 2002 and 2010, 45 (30%) had metastases at diagnosis. Seven patients had bilateral disease with additional visceral metastases. Nine patients who developed liver metastases during treatment were excluded. The site of metastases and the results of pretreatment biopsies were retrieved. Neo-adjuvant chemotherapy was combined with nutritional resuscitation, and aggressive supportive care. Post-operative treatment was determined by stage and histology. RESULTS Liver metastases were present in 19 (42%) patients but were the sole metastatic site in only 4 (9%). Overall survival at 5 years was 58.5%. Event Free Survival was 54%. Thirty-three (73%) had favourable histology, nine unfavourable and undetermined in three. No influence of histology on outcome was evident. Three patients had resection of persistent liver metastases. The pattern of metastatic disease had no influence on outcome. Despite aggressive supportive care two patients (4%) died within a week of presentation. Two patients died of chemotoxicity and two of complications following biopsy. Eight patients (17%) were lost to follow-up of whom five were on palliative treatment only. CONCLUSIONS In Africa liver metastases do not appear to worsen the prognosis of children with Stage IV WT. Despite the poor socio-economic circumstances survival is comparable to other countries.
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Affiliation(s)
- Daniel C Aronson
- Department of Paediatric Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
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Renin expression in adult renal epithelial tumors with granular cells. Pathol Res Pract 2010; 206:731-4. [DOI: 10.1016/j.prp.2010.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Revised: 06/04/2010] [Accepted: 06/04/2010] [Indexed: 10/19/2022]
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25
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Abstract
Wilms' tumor is the most common malignant renal tumor in children. Survival has improved dramatically over time as a result of prospective randomized clinical trials conducted by the pediatric cooperative cancer groups. Current research is directed toward identifying low-risk patients for whom a reduction in treatment intensity would decrease long-term morbidity. This article reviews the most recent advances in the biology and treatment of children with Wilms' tumor.
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Affiliation(s)
- Leah Nakamura
- Department of Urology, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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26
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Detección de renina en carcinomas cromófobos de células renales. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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