Screening for Wilms Tumor in High-Risk Individuals

circKL inhibits the growth and metastasis of kidney cancer by sponging miR‑182‑5p and upregulating FBXW7

Circular RNAs (circRNAs) are a type of non-coding RNA with important roles in the regulation of various biological processes involved in malignant progression. However, the potential molecular mechanisms and roles of circRNAs in kidney cancer have remained to be fully elucidated. In a previous study by our group, high-throughput microarray sequencing data were analyzed to determine the differentially expressed circRNAs in kidney cancer. In this analysis, a novel circRNA (hsa_circ_0100312, named circKL) was identified as a frequently downregulated circRNA in kidney cancer cells and tissues by reverse transcription-quantitative PCR. In the present study, Cell Counting Kit-8, colony formation, Transwell, wound-healing and mouse xenograft assays as well as a lung metastasis experiment were performed to confirm the functions of circKL. The experiments confirmed that circKL overexpression significantly inhibited the proliferation, migration, tumor growth and metastasis of kidney cancer both in vitro and in vivo. The potential molecular mechanisms of circKL were investigated by performing dual-luciferase and RNA immunoprecipitation assays. Western blot assays confirmed that overexpression of circKL significantly increased the protein level of F-box and WD repeat domain containing 7 (FBXW7). All results suggested that circKL suppressed the growth and migration of kidney cancer by sponging microRNA (miR)-182-5p and upregulating FBXW7 expression. Overall, the circKL/miR-182-5p/FBXW7 axis was indicated to have a key role in the growth and metastasis of kidney cancer and may be targeted as a novel therapeutic strategy.

Advanced-stage Wilms tumor arising in a horseshoe kidney of a 9-year-old child: a case report

BACKGROUND

Horseshoe kidney (HK) is one of the most common renal fusion abnormalities, with an incidence of 1:400 in the normal population. However, Wilms tumor (WT) arising in an HK is a rare occurrence. We report the case of a 9-year-old boy who presented with an advanced WT in an HK and also highlight the management challenges in a resource-poor setting such as ours.

CASE PRESENTATION

The patient was a 9-year-old Nigerian boy presented to the Pediatrics Outpatient Clinic of the University of Maiduguri Teaching Hospital (UMTH) with a history of progressive abdominal swelling, weight loss, abdominal pain, and cough. Abdominal examination revealed an irregular, firm, and non-tender mass in the right lumbar region. A computed tomography (CT) scan of the abdomen showed a heterogeneously dense mass that was predominantly to the right side of the abdomen and crossed the midline to the left side, where it continued with the relatively normal renal tissue. Chest CT revealed pulmonary metastases. A diagnosis of WT in an HK was made. The patient had a 6-week course of neoadjuvant chemotherapy, and a right nephrectomy and left partial nephrectomy was performed. The final histologic diagnosis of WT was made. Radiotherapy was intended but was not available in our facility, and the parents could not afford referral to another center.

CONCLUSIONS

Children with a clinically suspected HK with WT should undergo a careful imaging evaluation such as CT before any surgical intervention. Neoadjuvant chemotherapy to reduce tumor bulk might be a good treatment method to reduce surgical morbidity and aid in complete excision and potential for preserving renal function.

Global Research on Syndromic Surveillance from 1993 to 2017: Bibliometric Analysis and Visualization

Syndromic Surveillance aims at analyzing medical data to detect clusters of illness or forecast disease outbreaks. Although the research in this field is flourishing in terms of publications, an insight of the global research output has been overlooked. This paper aims at analyzing the global scientific output of the research from 1993 to 2017. To this end, the paper uses bibliometric analysis and visualization to achieve its goal. Particularly, a data processing framework was proposed based on citation datasets collected from Scopus and Clarivate Analytics’ Web of Science Core Collection (WoSCC). The bibliometric method and Citespace were used to analyze the institutions, countries, and research areas as well as the current hotspots and trends. The preprocessed dataset includes 14,680 citation records. The analysis uncovered USA, England, Canada, France and Australia as the top five most productive countries publishing about Syndromic Surveillance. On the other hand, at the Pinnacle of academic institutions are the US Centers for Disease Control and Prevention (CDC). The reference co-citation analysis uncovered the common research venues and further analysis of the keyword cooccurrence revealed the most trending topics. The findings of this research will help in enriching the field with a comprehensive view of the status and future trends of the research on Syndromic Surveillance.

Hereditary renal tumor syndromes: imaging findings and management strategies

OBJECTIVE

It is not rare for the radiologist to identify multiple renal masses and be the first to raise the possibility of a hereditary renal tumor syndrome. Characteristic renal and extrarenal imaging findings aid in making the correct diagnosis. The imaging findings, screening guidelines, and management techniques for the most common hereditary renal tumor syndromes are reviewed.

CONCLUSION

Hereditary renal tumor syndromes have specific screening guidelines and unique management techniques in which imaging plays a central role.

Incidence of abdominal tumors in syndromic and idiopathic hemihypertrophy/isolated hemihyperplasia

BACKGROUND

There is a reported increased risk of intra-abdominal tumors in children with both syndromic (SH) and isolated idiopathic hemihyperplasia (IH). Recommendations for tumor surveillance have been made, although there is no consensus for frequency and duration of screening. Our objective was to review the incidence of abdominal neoplasms in our pediatric population with SH and IH.

METHODS

We reviewed the diagnostic criteria, imaging findings, and any associated syndrome in all patients diagnosed with hemihypertrophy over a 10-year period.

RESULTS

One of 10 patients with SH, a child with Beckwith-Wiedemann syndrome, developed a hepatoblastoma resulting in a 10% tumor incidence in patients with SH. Three of the 250 (1.2%) children with IH developed an abdominal neoplasm. One was diagnosed with adrenal carcinoma and the other 2 with Wilms tumor.

CONCLUSIONS

We found an increased incidence of abdominal tumors in both SH and IH, however, our incidence of tumors with IH is lower than earlier reported studies. On the basis of this lower 1.2% incidence, the current literature on IH and available molecular genetic testing, it is reasonable to recommend referral of these patients to a clinical geneticist to identify subgroups with a higher risk for tumor development that are more likely to benefit from routine imaging surveillance.

LEVEL OF EVIDENCE

II-Retrospective study.

Renal agenesis in a child with ipsilateral hemihypertrophy

Hemihypertrophy is a clinical condition defined as an asymmetric enlargement of one side of the body. Inguinal hernias, renal cysts, cryptorchidism, ectasias of collecting tubes, medullary sponge kidney and horse-shoe kidney are examples of abnormalities associated with hemihypertrophy that have been described in the literature. We report here a 17.2-year-old patient with a left hemihypertrophy and renal agenesis with contralateral right compensatory renal hypertrophy together with normal renal function and blood pressure in the absence of proteinuria. He also presented with faint macular hyperpigmented skin lesions on his left upper arm, forehead and abdomen. To the best of our knowledge, this is the first report of renal agenesis and hemihypertrophy in the same patient. Hemihypertrophy can be seen as a component of Klippel-Trenaunay-Weber syndrome. The other components of this syndrome are varicose veins, skin naevus and arteriovenous malformations. Although renal agenesis, hemihypertrophy and hyperpigmented macular skin lesions (skin naevuses) may be incidental findings, together they may form a variant of Klippel-Trenaunay-Weber syndrome, as in our case.

Renal cell carcinoma as a second malignant neoplasm in a patient with non-syndromic hemihypertrophy and previous Wilms tumor

Survivors of childhood Wilms tumors are at an increased risk of second malignant neoplasms. Recently, it has been postulated that renal cell carcinoma is among the malignancies for which this population is at risk. We present the unique case of an adult Wilms tumor survivor with non-syndromic hemihypertrophy (NSHH) who developed renal cell carcinoma. This case highlights the need for close follow-up in two populations: adults who have survived Wilms tumor and those with NSHH.

Wilms tumor screening is unnecessary in Klippel-Trenaunay syndrome

BACKGROUND

Children with hemihypertrophy are screened for Wilms tumor, because this condition is a risk factor for developing the neoplasm. Patients with Klippel-Trenaunay syndrome (KTS) are often considered potential candidates for Wilms tumor, because they have unilateral overgrowth of the lower limb. In our experience, however, an association between KTS and Wilms tumor has not been observed.

METHODS

To determine whether KTS and Wilms tumor are associated, we reviewed our institutional experience for patients with both diagnoses and searched the Klippel-Trenaunay literature for patients with Wilms tumor. The National Wilms Tumor Study Group database also was studied to identify patients with KTS. Two-sided exact binomial tests were used to evaluate whether patients with 1 condition had an increased risk for the other. Ninety-five percent confidence intervals for these 2 risks were compared with the general population risks of Wilms tumor (1 in 10 000) and KTS (1 in 47 313).

RESULTS

None of the 115 patients with KTS followed at our institution developed Wilms tumor. One case of Wilms tumor has been reported in 1363 patients with KTS in the literature, giving a confidence interval of (1/57 377) and (1/267). None of the 8614 patients in the National Wilms Tumor Study Group database had KTS, giving a confidence interval of (0, 1/2336). Because the risks of KTS and Wilms tumor in the population fall within these confidence intervals, one cannot conclude that the risks of KTS among Wilms tumor patients or Wilms tumor among KTS patients are any different from the corresponding risks in the general population.

CONCLUSIONS

Patients with KTS are not at increased risk for developing Wilms tumor and thus should not undergo routine ultrasonographic screening.

Wilms' tumor and horseshoe kidneys: a case report and review of the literature

The presence of Wilms' tumor with a horseshoe kidney is an unusual combined clinical presentation. It has been reported that the incidence of Wilms' tumor in patients with horseshoe kidneys is higher than that seen in the general population. The current report describes a 5-year-old boy who presented with a stage III Wilms' tumor in a horseshoe kidney. The patient was treated with neoadjuvant chemotherapy followed by surgical resection, adjuvant chemotherapy, and radiation. The patient is disease free 40 months after diagnosis. A review of all reported cases of Wilms' tumor with horseshoe kidneys in the English-language literature before July 2002 is presented.

[Nephroblastomatosis: which therapeutic approach should be used? Report of 2 cases]

Nephroblastomatosis is a complex of pathological conditions defined by the persistence of nephrogenic elements after the conclusion of nephrogenesis (beyond week 36 of gestation) that conserve the capacity to evolve into nephroblastoma. Luckily, this malignant transformation is exceptional (< 1%(1)), which is why the disease is considered to have a good prognosis. The nephrogenic remains are frequently associated with beckwith-Wiedemann syndrome, hemihypertrophy and aniridia, in which case there is a greater risk of the development of Wilms tumor. Consequently, these children must be followed-up closely. The difficulty lay in knowing when to act, which children should be treated, and what treatment is appropriate because what little has been published in the literature is debatable. We report the cases of two patients, one with unilateral nephroblastomatosis and the other bilateral, who required surgical treatment after not responding to chemotherapy; and we expose our therapeutic algorithm and follow-up strategy.

Wilms' tumor in a case with Möbius' syndrome associated with arthrogryposis and mega cisterna magna

Möbius' syndrome is a rare congenital anomaly characterized by paralysis of the 7th and other cranial nerves and musculoskeletal abnormalities. We report a patient with Möbius' syndrome associated with arthrogryposis and mega cisterna magna in addition to the classic components of this syndrome. The case is interesting because she developed Wilms' tumor at 21 months of age. To our knowledge, this is the first case of this association reported in the literature.

Follow-up and management of recurrent Wilms' tumor

Over the past 3 decades, enormous advances have been made in the creation of a standardized treatment protocol for Wilms' tumor. Less morbid regimens for low-risk patients and more efficacious aggressive treatment protocols for high-risk patients have been developed, and continue to be improved with newer studies, such as the NWTS-V. An area that has posed a more challenging aspect of the disease is its relapse. Although a standard follow-up protocol has been produced by in-depth evaluation of previous works, there has been a great deal of difficulty demonstrating improved relapse-free and overall survival rates in re-treatment of children suffering from recurrent Wilms' tumor. Several factors are involved in the success of treatment of relapse, some of which include prerelapse treatment of initial disease and stage, site, and timing of recurrence. New agents and their combination with chemotherapeutics that already have established efficacy are being used for treatment of Wilms' tumor relapse, with varying success. These studies should lead the way for newer investigations in the future. Patients with anaplastic disease, rhabdoid tumors, and clear cell sarcoma are especially in need of these future investigations. Perhaps the true final frontier is establishing the likelihood of patients suffering a relapse. This topic currently is being studied in the fields of biologic markers and gene expression. This knowledge will hopefully, in turn, tailor initial treatment in a more specific manner.

Myeloid leukemia in Prader-Willi syndrome

OBJECTIVE

To evaluate the frequency of cancers recorded by the Surveillance, Epidemiology, and End Results (SEER) Program in persons with Prader-Willi syndrome (PWS) METHODS: A survey was mailed in 1994 to 1852 registrants of the PWS Association (USA) inquiring about a diagnosis of any type of benign tumor or cancer (malignant tumor or leukemia). The risk of developing cancer was then estimated by comparing the observed number of cancers in the PWS population during 1975 to 1994 to the expected number in the general US population using data from the 1971-1994 SEER Cancer Statistics Review.

RESULTS

Of the 1852 persons, 1160 (63%) responded, or 75% (1160/1552) of those who received the survey. The total number of observed cancer cases in the PWS study population was 8 versus 4.80 expected in the general US population (P =.1610). Three cases of myeloid leukemia were observed versus 0.075 leukemias expected (P =.0001).

CONCLUSIONS

There appears to be an increased risk of myeloid leukemias, but not other cancers, among persons with PWS.

Malignant abdominal masses in children: quick guide to evaluation and diagnosis

A palpable mass in the abdomen of a child is a serious finding. In this article the authors present their single-institution experience of how these malignancies present and their distribution by age and diagnosis. The most common abdominal malignancies diagnosed in the pediatric population include neuroblastoma, Wilms' tumor, hepatoblastoma, lymphoma, and germ cell tumors. This article provides the busy general pediatrician with some guidelines of how to proceed after discovering a suspiciousmass.

Hemihypertrophy

Hemihypertrophy refers to asymmetry of the body to a greater degree than can be attributed to normal variation. Most causes can be diagnosed from history and physical examination. Hemihypertrophy is cosmetically unsightly and the psychological impact can be quite prolonged. This article reviews the causes and differential diagnosis of hemihypertrophy and offers an approach to the management of this condition. Children with isolated hemihypertrophy are at increased risk for neoplasms. Periodic abdominal ultrasound examination and physical examination during infancy and childhood are recommended for early tumour detection.

Wilms' tumor. Overview of National Wilms' Tumor Study Group results

Since its inception in 1969, the NWTSG has performed successful studies that are now the model for the management of pediatric malignancies. Future studies may use genetic markers to stratify high-risk patients beyond the traditional staging system. Therapy will continue to be evaluated to determine the minimal therapy necessary to achieve the best outcome for children with Wilms' tumor.

Characteristics and outcome of children with Beckwith-Wiedemann syndrome and Wilms' tumor: a report from the National Wilms Tumor Study Group

PURPOSE

Children with Beckwith-Wiedemann syndrome (BWS) are at increased risk for developing Wilms' tumor (WT). We reviewed the National Wilms Tumor Study Group (NWTSG) records to assess clinical characteristics and outcome of patients with WT and BWS.

METHODS

In the NWTSG, treating clinicians were asked to report, for each enrolled patient, whether the patient had BWS. Between 1980 and 1995, 4,669 patients were treated on two consecutive NWTSG protocols (NWTS 3 and NWTS 4). We retrospectively reviewed the clinical characteristics and treatment outcomes of BWS patients compared with patients with WT without BWS.

RESULTS

Fifty-three children enrolled onto NWTS 3 and 4 were reported to have BWS. BWS patients were more likely to present with lower-stage tumors (P =.0001), with more than half (27 of 53) presenting with stage I disease. The overall treatment outcomes for the BWS patients were nearly identical to those without BWS, with overall survival at 4 years from diagnosis at 89% and 90%, respectively. Overall, 21% of the patients with BWS had bilateral disease, either at diagnosis (nine of 53) or as metachronous contralateral recurrence (two of 53). BWS patients enrolled onto NWTS 4 had smaller tumors than those enrolled onto NWTS 3 (P =.02), a trend not seen in the non-BWS patients.

CONCLUSION

Like children without BWS, children with BWS and WT have an excellent prognosis with modern treatment regimens. There is a high risk of bilateral disease, and increasingly smaller tumors are being detected. This suggests that a national trial assessing the role of ultrasound screening followed by nephron-sparing surgery for some patients may be appropriate.

Recognition and management of childhood cancer syndromes: a systems approach

Recognition of congenital anomalies that predispose to childhood cancer allows for the institution of a cancer surveillance program, identification of relatives with increased cancer risk, and recurrence risk counseling. In this article, a systems approach to the diagnosis of 21 childhood cancer syndromes is set forth in the format of the pediatric physical examination. In the second part of this article, guidelines are presented for genetic testing, cancer screening, and genetic counseling for the 21 cancer syndromes.

Microdissecting the genetic events in nephrogenic rests and Wilms' tumor development

Nephrogenic rests are precursor lesions associated with about 40% of Wilms' tumors. This study identifies genetic steps occurring in the development of Wilms' tumor. Thirty-four Wilms' tumors with nephrogenic rests and/or areas of anaplasia were microdissected from paraffin sections to determine whether and at what stage loss of heterozygosity (LOH) occurred, using polymerase chain reaction-based polymorphic markers at 11p13, 11p15, and 16q. LOH at these loci have been identified in Wilms' tumors and are associated with identified or putative tumor suppressor genes. Three cystic nephromas/cystic partially differentiated nephroblastomas were also examined. LOH was detected in six cases at 11p13 and in six cases at 11p15, and two of these cases had LOH at both loci. All intralobar rests showing LOH also showed LOH in the tumor. A case with a small perilobar rest showed LOH of 11p13 only in the tumor. Five cases showing LOH at 16q were identified (this was identified only in the tumor, and not in the associated rest), and three of these had recurrence of the tumor. Two cases had a WT1 mutation (one germline and the other somatic), as well as LOH in both the intralobar rest and the tumor. A cystic partially differentiated nephroblastoma showed loss at 11p13 and 11p15, as well as at 16q. This study suggests that LOH at 11p13 and 11p15 and WT1 mutations are early events but that LOH at 16q occurs late in the pathogenesis of Wilms' tumor. Intralobar and perilobar nephrogenic rests are known to have different biological behaviors, and this study suggests that they are genetically different. A multistep model of Wilms' tumor pathogenesis is supported by these findings.

Wilms' tumor

Wilms' tumor is the most common renal malignancy of childhood. Survival rates for favorable histology of Wilms' tumor currently approach 90%. Recent advances in the molecular genetics of Wilms' tumor have led to insights into the genetic factors involved in the development of Wilms' tumor, normal renal development, and the mechanisms of tumorigenesis.