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Alijani B, Abbaspour E, Karimzadhagh S, Reihanian Z, Haghani Dogahe M, Jafari M, Jafari S, Zaresharifi N. First incidence of extrarenal wilms tumor within the spinal canal in the adult population: a novel case report and literature review. BMC Urol 2024; 24:119. [PMID: 38858693 PMCID: PMC11163749 DOI: 10.1186/s12894-024-01508-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Wilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms tumor (ERWT) emerges outside the renal boundaries and comprises 0.5 to 1% of all WT cases, with even rarer incidences in adults. Oncogenic mutations associated with ectopic nephrogenic rests (NR) may contribute to ERWT development. Diagnosis involves surgical resection and pathology examination. Due to scarce cases, adults often rely on pediatric guidelines. We thoroughly searched PubMed, Scopus, and Web of Science databases to establish our case's uniqueness. To the best of our knowledge, this is the first documented incidence of extrarenal Wilms tumor within the spinal canal in the adult population. CASE PRESENTATION A 22-year-old woman with a history of congenital lipo-myelomeningocele surgery as an infant presented with a 6-month history of back pain. This pain gradually resulted in limb weakness, paraparesis, and loss of bladder and bowel control. An MRI showed a 6 × 5 × 3 cm spinal canal mass at the L4-S1 level. Consequently, a laminectomy was performed at the L4-L5 level to remove the intramedullary tumor. Post-surgery histopathology and immunohistochemistry confirmed the tumor as ERWT with favorable histology without any teratomatous component. CONCLUSION This report underscores the rarity of extrarenal Wilms tumor (ERWT) in adults, challenging conventional assumptions about its typical age of occurrence. It emphasizes the importance of clinical awareness regarding such uncommon cases. Moreover, the co-occurrence of spinal ERWTs and a history of spinal anomalies warrants further investigation.
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Affiliation(s)
- Babak Alijani
- Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Abbaspour
- Department of Radiology, Poursina Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Sahand Karimzadhagh
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zoheir Reihanian
- Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Maryam Jafari
- Student Research Committee, School of Medicine, Anzali International Campus, Guilan University of Medical Sciences, Rasht, Iran
| | - Seifollah Jafari
- Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Nooshin Zaresharifi
- Neuroscience Research Center, Guilan University of Medical Sciences, Rasht, 41937-13194, Iran.
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Chan GJ, Stohr BA, Osunkoya AO, Croom NA, Cho SJ, Balassanian R, Charu V, Bean GR, Chan E. Wilms Tumor: An Unexpected Diagnosis in Adult Patients. Arch Pathol Lab Med 2024; 148:722-727. [PMID: 37756569 DOI: 10.5858/arpa.2023-0127-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT.— Wilms tumor (WT) in adult patients is rare and has historically been a diagnostic and therapeutic conundrum, with limited data available in the literature. OBJECTIVE.— To provide detailed diagnostic features, molecular profiling, and patient outcomes in a multi-institutional cohort of adult WT patients. DESIGN.— We identified and retrospectively examined 4 adult WT cases. RESULTS.— Two patients presented with metastatic disease, and diagnoses were made on fine-needle aspiration of their renal masses. The aspirates included malignant primitive-appearing epithelioid cells forming tubular rosettes and necrosis, and cell blocks demonstrated triphasic histology. In the remaining 2 cases, patients presented with localized disease and received a diagnosis on resection, with both patients demonstrating an epithelial-predominant morphology. Tumor cells in all cases were patchy variable positive for PAX8 and WT1 immunohistochemistry. Next-generation sequencing identified alterations previously reported in pediatric WT in 3 of 4 cases, including mutations in ASXL1 (2 of 4), WT1 (1 of 4), and the TERT promoter (1 of 4), as well as 1q gains (1 of 4); 1 case showed no alterations. Three patients were treated with pediatric chemotherapy protocols; during follow-up (range, 26-60 months), 1 patient died of disease. CONCLUSIONS.— WT is an unexpected and difficult entity to diagnose in adults and should be considered when faced with a primitive-appearing renal or metastatic tumor. Molecular testing may help exclude other possibilities but may not be sensitive or specific because of the relatively large number of driver mutations reported in WT.
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Affiliation(s)
- Garrett J Chan
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Bradley A Stohr
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Adeboye O Osunkoya
- the Departments of Pathology and Urology, Emory University School of Medicine, Atlanta, Georgia (Osunkoya)
| | - Nicole A Croom
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Soo-Jin Cho
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Ronald Balassanian
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Vivek Charu
- the Department of Pathology, Stanford University School of Medicine, Stanford, California (Charu, Bean)
| | - Gregory R Bean
- the Department of Pathology, Stanford University School of Medicine, Stanford, California (Charu, Bean)
| | - Emily Chan
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
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Farzadnia M, Karrabi M, Ghorbani H. Adult Wilms with Biphasic Pattern; A Case Report. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S421-S425. [PMID: 34760097 PMCID: PMC8559647 DOI: 10.22088/cjim.12.0.421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 11/27/2022]
Abstract
Background: Wilms' tumor, nephroblastoma, is an extremely uncommon kidney tumor of adulthood. We reported a woman with a huge kidney mass diagnosed with nephroblastoma. Case presentation: A 39-year-old female was assessed due to right flank pain. CT scan revealed a mass measuring 128×100 mms involving the upper portion of the right kidney. The patient underwent nephrectomy, and the diagnosis of adult Wilms' tumor was confirmed based on the morphological and immunohistochemical findings. Conclusion: In adult patients with flank pain and renal mass, the diagnosis of Wilms' tumor should be pronounced in the absence of histopathologic features of renal cell carcinoma.
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Affiliation(s)
- Mahdi Farzadnia
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahboobe Karrabi
- Department of Pathology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Ghorbani
- Kidney Transplantation Complication Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Tripathi S, Mishra A, Popat VC, Husain SA. Wilms' Tumor in Adults-Conventional and Unconventional Presentations of a Rare Entity with a Review of Literature. J Kidney Cancer VHL 2021; 8:40-48. [PMID: 34322362 PMCID: PMC8297498 DOI: 10.15586/jkcvhl.v8i2.186] [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: 06/11/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022] Open
Abstract
Wilms' tumor (WT) in adults is a rare neoplasm. Only a few reports are available in the literature. The tumor often masquerades as renal cell carcinoma (RCC). For accurate reporting, histopathological examination (HPE) plays a vital role in early diagnosis and prompt administration of multimodality treatment helps to improve the prognosis. We comprehensively analyzed five cases of adult WT presenting in the third to fifth decade with flank pain, hematuria, fever, and palpable lump. After complete clinical, biochemical, radiological, and HPE evaluation, tumor was staged and treatment was planned accordingly. Patients with low-stage WT were treated with open radical nephrectomy and chemotherapy. One of the patients diagnosed with inferior vena cava (IVC) thrombus apart from the above treatment also underwent IVC thrombectomy. Another young male presenting with distant metastasis (stage IV) and focal anaplasia on histology received preoperative chemotherapy and then planned for surgery. Unfortunately, the tumor being unresectable, second-line chemotherapy was given but he ultimately succumbed to death. All other patients are on regular follow-up and disease-free. Adult nephroblastoma is a rare clinical entity with hostile behavior. The presence of IVC thrombus is not a contraindication to surgery. Although the management strategy as per pediatric protocol by the inclusion of multimodality approach improves survival, still the overall prognosis in adults is dismal. There is a need for a standardized treatment protocol to encourage a homogenous approach for this rare disease and thereby improve survival.
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Affiliation(s)
- Sujata Tripathi
- Department of Pathology & Blood cell, Rana Beni Madhav District Hospital, Raebareli, India
| | - Amit Mishra
- Department of Urology, AIIMS, Raebareli, India
| | - Vijay C. Popat
- Department of Pathology, MP Shah Government Medical College, Jamnagar, India
| | - Syed Altaf Husain
- Department of Radio Diagnosis, Rana Beni Madhav District hospital, Raebareli, India
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Dai J, He HC, Yang XQ, Huang X, Fang C, He W, Zhao JP, Sun FK. Primary malignant teratoma of the kidney: a rare case report and literature review. Transl Androl Urol 2021; 10:1807-1812. [PMID: 33968669 PMCID: PMC8100854 DOI: 10.21037/tau-21-97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Teratomas originate from pluripotent cells and can differentiate along one or more embryonic germ lines. Renal teratoma is infrequent and malignant renal teratoma is even rarer. Experience in the diagnosis and treatment of this uncommon malignancy is seriously limited. In this report, we described the case of a 64-year-old female who complained of right flank pain for 4 months. Computed tomography (CT) revealed a hypodense mass (50 mm in maximum diameter) with slow contrast enhancement and obscure boundary located in the lower pole of the right kidney. CT also showed multiple retroperitoneal lymphadenectasis. Retroperitoneal laparoscopic right radical nephrectomy along with regional lymphadenectomy was successfully performed, and postoperative pathological examination confirmed malignant teratoma of the kidney. After surgery, the patient received adjuvant chemotherapy with BEP (bleomycin, etoposide, and cisplatin) protocol. At the 6-month follow-up, pulmonary and liver metastases were discovered by CT and the patient refused any further treatment. Unfortunately, she died at 16 months postoperatively. Although primary renal malignant teratoma is extremely rare, this kind of tumor should be taken into consideration. Currently, there is no therapeutic standard consensus for this disease and the prognosis remains unclear. Early detection and surgical intervention is critical, and more research on postoperative adjuvant therapy should be performed.
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Affiliation(s)
- Jun Dai
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Hong-Chao He
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xiao-Qun Yang
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xin Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Chen Fang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Wei He
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Ju-Ping Zhao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Fu-Kang Sun
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Kasenda S, Mategula D, Chiphangwi N, Gadama LA, Masamba LPL. High-Risk Adult Wilms' Tumour in Pregnancy: A Case Report. Malawi Med J 2019; 31:155-158. [PMID: 31452850 PMCID: PMC6698624 DOI: 10.4314/mmj.v31i2.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Wilms' tumour is the most common renal neoplasm in children with an incidence of 10 cases per 1 million children and a median age at diagnosis of 3.5 years. In Western countries its occurrence in adults is 0.2 cases per million people in western countries and carries a poorer prognosis. The co-existence of Adult Wilms' tumour and pregnancy is extremely rare with less than 20 cases published in the English literature. We present a case of a Malawian woman who had progressive high-risk metastatic Adult Wilms' tumour in pregnancy after nephrectomy, radiotherapy and two lines of chemotherapy.
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Affiliation(s)
| | - Donnie Mategula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Noel Chiphangwi
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Luis Aaron Gadama
- Department of Obstetrics and Gynaecology Department, University of Malawi College of Medicine, Blantyre, Malawi.,Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
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Abstract
RATIONALE Teratomas commonly arise in the gonads, including ovary and testis. The kidney is one of the most rare regions of primary teratoma. To date, about 19 cases of renal teratoma have been reported, and only 3 articles have reported renal immature teratoma; however, all of them occur in infant or children. In the present study, we reported a renal inmature teratoma in a male adult. PATIENT CONCERNS The present patient was a middle-aged man with aching pain in the left waist, and contrast-enhanced CT showed a lump in the left kidney with mild-to-moderate enhancement, and a low density small necrotic area was seen in the center. DIAGNOSIS, INTERVENTIONS, AND OUTCOMES The patient underwent radical nephrectomy. Based on postsurgical histopathology, the final diagnosis of this case was renal immature teratoma. Postoperative chemotherapy was carried out, and the patient has been followed-up for 18 months without tumor recurrence. LESSONS Adult renal immature teratoma is rare, and the diagnosis is mainly based on the pathological findings.
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Modi S, Tiang KW, Inglis P, Collins S. Adult Wilms' Tumour: Case Report and Review of Literature. J Kidney Cancer VHL 2016; 3:1-7. [PMID: 28326278 PMCID: PMC5347375 DOI: 10.15586/jkcvhl.2016.52] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/20/2016] [Indexed: 11/18/2022] Open
Abstract
Wilms' tumour (nephroblastoma) is the most common renal tumour in children. Wilms' tumour in adults is extremely rare and has a poorer prognosis than paediatric Wilms' tumour. It is difficult to differentiate adult Wilms' tumour from renal cell carcinoma based on radiological findings alone. The diagnosis in adults is often serendipitous following nephrectomy for presumed renal cell carcinoma. Because of the paucity of literature, there are no standard protocols for the management of adult Wilms' tumour, and therefore, it is managed as per paediatric Wilms' tumour. Herein, we report the case of adult Wilms' tumour in a 43-year-old man, which was diagnosed unexpectedly following nephrectomy for presumed renal cell carcinoma.
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Affiliation(s)
- Sunny Modi
- Urology Department, Greenslopes Private Hospital, Brisbane, Australia; Royal Brisbane and Women’s Hospital, Brisbane, Australia; Sunshine Coast University Private Hospital, Sunshine Coast, Australia
| | - Kor Woi Tiang
- Urology Department, Greenslopes Private Hospital, Brisbane, Australia; Royal Brisbane and Women’s Hospital, Brisbane, Australia; Sunshine Coast University Private Hospital, Sunshine Coast, Australia
| | - Po Inglis
- Urology Department, Greenslopes Private Hospital, Brisbane, Australia; Royal Brisbane and Women’s Hospital, Brisbane, Australia; Sunshine Coast University Private Hospital, Sunshine Coast, Australia
| | - Stuart Collins
- Urology Department, Greenslopes Private Hospital, Brisbane, Australia; Royal Brisbane and Women’s Hospital, Brisbane, Australia; Sunshine Coast University Private Hospital, Sunshine Coast, Australia
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Abstract
Wilms tumor (WT) is the most common neoplasm of the kidney in children. It is an embryologic tumor that histologically mimics renal embryogenesis and is composed of a variable mixture of stromal, blastemal, and epithelial elements. Nephrogenic rests, generally considered to be precursor lesions of the WT, are foci of the embryonic metanephric tissue that persist after the completion of renal embryogenesis. These are classified as perilobar and intralobar based on their location and maybe present as single or multiple foci. Intralobar and perilobar rests and the tumors arising from these rests differ morphologically and are characterized by 2 different sets of genetic abnormalities involving 2 adjacent foci, WT1 and WT2, on the short arm of chromosome 11. WTs arising in the intralobar rests tend to be stromal predominant and have a mutation or deletion of WT1. Germline mutation in WT1 may be associated with syndromic conditions such as WAGR and Denys-Drash syndromes. Perilobar rests and their corresponding tumors usually have loss of imprinting/loss of heterozygosity involving WT2, which contains several parentally imprinted genes. Loss of function of these genes, if present constitutionally, may be associated with Beckwith-Wiedemann syndrome or may result in isolated hypertrophy. Abnormalities in several other genes may also be seen in WT. These include WTX, (on chromosome X), CTNNB1 (chromosome 3), and TP53 (chromosome 17) among others. WT with loss of heterozygosity at 1p and 16q may have poor prognosis, requiring aggressive therapy. Treatment modalities for WT have evolved over many decades, primarily through the efforts of Dr J Bruce Beckwith at National WT study. This work is now being carried out by Children Oncology Group in North America and International Society of Pediatric Oncology in Europe. Although their therapeutic approaches are somewhat different, both have reported excellent results with equally high cure rates.
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Idrissi-Serhrouchni K, El-Fatemi H, El madi A, Benhayoun K, Chbani L, Harmouch T, Bouabdellah Y, Amarti A. Primary renal teratoma: a rare entity. Diagn Pathol 2013; 8:107. [PMID: 23800134 PMCID: PMC3751105 DOI: 10.1186/1746-1596-8-107] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/05/2013] [Indexed: 11/30/2022] Open
Abstract
Teratomas are neoplasms that arise from pluripotent cells and can differentiate along one or more embryonic germ lines. Renal teratoma is an exceedingly rare condition. Teratomas commonly arise in the gonads, sacrococcygeal region, pineal gland, and retroperitoneum. They present mainly as an abdominal mass with few other symptoms. Majority of the tumors are benign, situated on the left side and para renal, occasional lesions are bilateral. If diagnosed early, they are amenable to curative excision.Renal teratomas are rare and most have been dismissed as cases of teratoid nephroblastomas or retroperitoneal teratomas secondarily invading the kidney. The differentiation between these two neoplasms in the kidney is often problematic.We present a case of intrarenal immature teratoma in a six-month-old baby girl. VIRTUAL SLIDES The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1746249869599954.
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Affiliation(s)
| | - Hinde El-Fatemi
- Department of Pathology, Hassan II University Hospital, Fez 30000, Morocco
| | - Aziz El madi
- Department of Pediatric Surgery, Hassan II University Hospital, Fez 30000, Morocco
| | - Khadija Benhayoun
- Department of Pathology, Hassan II University Hospital, Fez 30000, Morocco
| | - Laila Chbani
- Department of Pathology, Hassan II University Hospital, Fez 30000, Morocco
| | - Taoufik Harmouch
- Department of Pathology, Hassan II University Hospital, Fez 30000, Morocco
| | - Youssef Bouabdellah
- Department of Pediatric Surgery, Hassan II University Hospital, Fez 30000, Morocco
| | - Afaf Amarti
- Department of Pathology, Hassan II University Hospital, Fez 30000, Morocco
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Huszno J, Starzyczny-Słota D, Jaworska M, Nowara E. Adult Wilms' tumor - diagnosis and current therapy. Cent European J Urol 2013; 66:39-44. [PMID: 24578986 PMCID: PMC3921847 DOI: 10.5173/ceju.2013.01.art12] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Wilms' tumour is one of the commonest malignant tumours of childhood. It appears mainly in the first 5 years of life. Incidental examples of nephroblastoma in adults have been described in literature (about 3% of all described cases). There are diagnostic and therapeutic difficulties in that older age group. The preoperative diagnosis of nephroblastoma in adults is difficult because there are no specific radiographic findings that allow to distinguished it from the more common adult renal tumors. Histopathologically, there is no difference between adult and childhood Wilms' tumor. MATERIALS AND METHODS The PubMed database and current literature search was conducted for reports on clinical and histopathological features of nephroblastoma in adults. We also reviewed the literature in terms of treatment strategy, toxicity and prognostic factors. RESULTS Up till now, several biological factors have been identified that may be in future new prognostic factors. Modern treatment regiments improved OS in this group of patients (OS rates of 90%). The prognosis remain still worse for about 25% of patients with anaplastic, bilateral and recurrent disease. CONCLUSIONS Due to the fact that nephroblastoma is a very rare type of cancer, adult patients should be treated in an individual way based on the available schemes used in children. Toxicity in adults is higher than in children.
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Affiliation(s)
- Joanna Huszno
- Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Danuta Starzyczny-Słota
- Clinical and Experimental Oncology Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Magdalena Jaworska
- Tumor Pathology Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
| | - Elżbieta Nowara
- Clinical and Experimental Oncology Department, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland
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