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van der Beek JN, Schenk JP, Morosi C, Watson TA, Coma A, Graf N, Chowdhury T, Ramírez-Villar GL, Spreafico F, Welter N, Dzhuma K, van Tinteren H, de Krijger RR, van den Heuvel-Eibrink MM, Littooij AS. Diagnostic magnetic resonance imaging characteristics of congenital mesoblastic nephroma: a retrospective multi-center International Society of Pediatric Oncology-Renal Tumor Study Group (SIOP-RTSG) radiology panel study. Pediatr Radiol 2024; 54:965-976. [PMID: 38609702 PMCID: PMC11111520 DOI: 10.1007/s00247-024-05918-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Congenital mesoblastic nephroma is the most common solid renal tumor in neonates. Therefore, patients <3 months of age are advised to undergo upfront nephrectomy, whereas invasive procedures at diagnosis in patients ≥3 months of age are discouraged by the International Society of Pediatric Oncology-Renal Tumor Study Group (SIOP-RTSG). Nevertheless, discriminating congenital mesoblastic nephroma, especially from the more common Wilms tumor, solely based on imaging remains difficult. Recently, magnetic resonance imaging (MRI) has become the preferred modality. Studies focusing on MRI characteristics of congenital mesoblastic nephroma are limited. OBJECTIVE This study aims to identify diagnostic MRI characteristics of congenital mesoblastic nephroma in the largest series of patients to date. MATERIALS AND METHODS In this retrospective multicenter study, five SIOP-RTSG national review radiologists identified 52 diagnostic MRIs of histologically proven congenital mesoblastic nephromas. MRI was performed following SIOP-RTSG protocols, while radiologists assessed their national cases using a validated case report form. RESULTS Patients (24/52 classic, 11/52 cellular, and 15/52 mixed type congenital mesoblastic nephroma, 2/52 unknown) had a median age of 1 month (range 1 day-3 months). Classic type congenital mesoblastic nephroma appeared homogeneous with a lack of hemorrhage, necrosis and/or cysts, showing a concentric ring sign in 14 (58.3%) patients. Cellular and mixed type congenital mesoblastic nephroma appeared more heterogeneous and were larger (311.6 and 174.2 cm3, respectively, versus 41.0 cm3 for the classic type (P<0.001)). All cases were predominantly T2-weighted isointense and T1-weighted hypointense, and mean overall apparent diffusion coefficient values ranged from 1.05-1.10×10-3 mm2/s. CONCLUSION This retrospective international collaborative study showed classic type congenital mesoblastic nephroma predominantly presented as a homogeneous T2-weighted isointense mass with a typical concentric ring sign, whereas the cellular type appeared more heterogeneous. Future studies may use identified MRI characteristic of congenital mesoblastic nephroma for validation and for exploring the discriminative non-invasive value of MRI, especially from Wilms tumor.
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Affiliation(s)
- Justine N van der Beek
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
| | - Jens-Peter Schenk
- Clinic of Diagnostic and Interventional Radiology, Division of Pediatric Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tom A Watson
- Department of Paediatric Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ana Coma
- Department of Pediatric Radiology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Norbert Graf
- Department of Pediatric Oncology & Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Tanzina Chowdhury
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Filippo Spreafico
- Pediatric Oncology Unit, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nils Welter
- Department of Pediatric Oncology & Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Kristina Dzhuma
- Developmental Biology and Cancer Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Division of Child Health, Wilhelmina Children's Hospital, Utrecht University, Utrecht, The Netherlands
| | - Annemieke S Littooij
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht/Wilhelmina Children's Hospital, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Athapathu AS, Wijayawardhana SM, Meegoda J, Gunaratne SA, Somathilaka M, Chang KTE, Wickramasinghe P. Case report of an infant with congenital mesoblastic nephroma leading to pulmonary metastasis. SAGE Open Med Case Rep 2023; 11:2050313X231220826. [PMID: 38149118 PMCID: PMC10750505 DOI: 10.1177/2050313x231220826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Congenital mesoblastic nephroma is considered a tumour with favourable clinical behaviour with only few reported cases of metastases. We report an infant who underwent complete resection and later developed pulmonary metastasis. Ten-month-old baby girl initially presented at 3 weeks of age with macroscopic haematuria, hypertension and a lumbar mass. Contrast-enhanced computed tomography revealed a tumour arising from the left kidney without local invasion or metastasis. She underwent left nephrectomy. Immunohistochemistry confirmed a cellular type of congenital mesoblastic nephroma. At 10 months, she presented with difficulty in breathing. Contrast-enhanced computed tomography revealed an opacity in the right hemi-thorax. Histology of lung mass was suggestive of deposits from the previously excised mesoblastic nephroma. She developed a right-sided haemothorax and succumbed. This case report highlights the fact that even though congenital mesoblastic nephromas are considered tumours with favourable clinical behaviour, they can present later with distant metastasis. Therefore, clinicians need to be aware of this rare malignant potential and adhere to meticulous follow-up protocols.
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Affiliation(s)
- Arjuna Salinda Athapathu
- Faculty of Medicine, Department of Paediatrics, University of Kelaniya, Ragama, Sri Lanka
- Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
- University Paediatrics Unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | | | - Jithmal Meegoda
- Faculty of Medicine, Department of Pathology, University of Colombo, Colombo, Sri Lanka
| | - Sandini A Gunaratne
- Department of Histopathology, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
| | | | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
| | - Pujitha Wickramasinghe
- University Paediatrics Unit, Lady Ridgeway Hospital for Children, Colombo, Sri Lanka
- Faculty of Medicine, Department of Paediatrics, University of Colombo, Colombo, Sri Lanka
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3
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Samha R, Mansour M, AlAwad Y, Almaalouli B, Mayhoob R, Al Sabbagh A, Aljundi R, Barakat A. A massive primary congenital mesoblastic nephroma was successfully managed through open total nephrectomy: a case report. Ann Med Surg (Lond) 2023; 85:6159-6163. [PMID: 38098567 PMCID: PMC10718342 DOI: 10.1097/ms9.0000000000001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/19/2023] [Indexed: 12/17/2023] Open
Abstract
Background Congenital mesoblastic nephroma is the most common renal tumor in children under the age of 6 months, comprising 3-10% of all kidney tumors in children. It is a rare and mostly benign tumor. It divides into cellular, classic, and mixed subtypes. It is typically detected in the third trimester of pregnancy using ultrasonography and magnetic resonance imaging. The best treatment is surgically by completely removing the tumor. Case presentation We reported a case of a one-day-old female who was born at 31 weeks gestation weighing 1670 g. Preterm labor was due to polyhydramnios, which was diagnosed predelivery. A large mass was detected in the left hypochondrium using computerized tomography, total nephrectomy was performed, and the histopathological examination of the specimen confirmed the diagnosis of congenital mesoblastic nephroma. Clinical discussion and conclusion Early polyhydramnios could be the most significant sign of renal tumors in infants, especially congenital mesoblastic nephroma.
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Affiliation(s)
| | - Marah Mansour
- Faculty of Medicine, Tartous University
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic Hospital, Rochester, Minnesota, USA
| | - Yara AlAwad
- Faculty of Medicine, Damascus University, Damascus
| | | | - Reema Mayhoob
- Faculty of Medicine, Tishreen University, Latakia, Syrian Arab Republic
| | | | - Rama Aljundi
- Faculty of Medicine, Damascus University, Damascus
| | - Ali Barakat
- Faculty of Medicine, Tartous University
- Department of Pediatric Surgery, Al Mashreq Hospital, Tartous
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4
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De Wilde K, Zuberi J. Case report: Congenital mesoblastic nephroma. Int J Surg Case Rep 2023; 106:108233. [PMID: 37141775 DOI: 10.1016/j.ijscr.2023.108233] [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: 09/24/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Congenital mesoblastic nephroma is a common benign renal tumor that mainly affects infants below the age of six months (Daskas et al., 2002). Identifying the pathology type is crucial for determining the appropriate plan of action and predicting the patient's prognosis. CASE PRESENTATION A one-day-old Hispanic neonate was referred for surgical evaluation after detecting a LUQ mass. Ultrasound imaging revealed a heterogenous solid mass that infiltrated the hilum of the left kidney. The patient underwent a left radical nephrectomy, and the pathology results indicated that the mass was consistent with the classic type of congenital mesoblastic nephroma. The patient will be closely monitored by nephrology with frequent abdominal ultrasounds. CLINICAL DISCUSSION The case describes a one-day-old female baby with an asymptomatic LUQ abdominal mass, which was diagnosed as mesoblastic nephroma. The baby was born full-term with no significant medical history, and after experiencing hypertensive episodes, she underwent a left radical nephrectomy to remove the tumor. Pathology confirmed mesoblastic nephroma, classic type, and the patient was diagnosed with stage I disease since the tumor was entirely resected with no renal vessel involvement. Follow-up ultrasounds were recommended to monitor for recurrence, and chemotherapy may be considered if recurrence occurs (Pachl et al., 2020). Calcium and renin levels should also be monitored (Bendre et al., 2014). CONCLUSION Although congenital mesoblastic nephroma is typically benign, patients require ongoing monitoring for potential paraneoplastic syndromes. Furthermore, certain types of mesoblastic nephroma can progress to malignancy, necessitating close follow-up during the first few years of life.
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Affiliation(s)
- Kristen De Wilde
- St. George's School of Medicine, 3500 Sunrise Hwy, Great River, NY 11739, United States of America.
| | - Jamshed Zuberi
- Department of General Surgery, St. Joseph's University Medical Center, 703 Main St, Paterson, NJ 07503, United States of America
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Koo SC, Schieffer KM, Lee K, Gupta A, Pfau RB, Avenarius MR, Stonerock E, LaHaye S, Fitch J, Setty BA, Roberts R, Ranalli M, Conces MR, Bu F, Mardis ER, Cottrell CE. EGFR internal tandem duplications in fusion-negative congenital and neonatal spindle cell tumors. Genes Chromosomes Cancer 2023; 62:17-26. [PMID: 35801295 DOI: 10.1002/gcc.23087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022] Open
Abstract
Next-generation sequencing (NGS) assays can sensitively detect somatic variation, and increasingly can enable the identification of complex structural rearrangements. A subset of infantile spindle cell sarcomas, particularly congenital mesoblastic nephromas with classic or mixed histology, have structural rearrangement in the form of internal tandem duplications (ITD) involving EGFR. We performed prospective analysis to identify EGFR ITD through clinical or research studies, as well as retrospective analysis to quantify the frequency of EGFR ITD in pediatric sarcomas. Within our institution, three tumors with EGFR ITD were prospectively identified, all occurring in patients less than 1 year of age at diagnosis, including two renal tumors and one mediastinal soft tissue tumor. These three cases exhibited both cellular and mixed cellular and classic histology. All patients had no evidence of disease progression off therapy, despite incomplete resection. To extend our analysis and quantify the frequency of EGFR ITD in pediatric sarcomas, we retrospectively analyzed a cohort of tumors (n = 90) that were previously negative for clinical RT-PCR-based fusion testing. We identified EGFR ITD in three analyzed cases, all in patients less than 1 year of age (n = 18; 3/18, 17%). Here we expand the spectrum of tumors with EGFR ITD to congenital soft tissue tumors and report an unusual example of an EGFR ITD in a tumor with cellular congenital mesoblastic nephroma histology. We also highlight the importance of appropriate test selection and bioinformatic analysis for identification of this genomic alteration that is unexpectedly common in congenital and infantile spindle cell tumors.
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Affiliation(s)
- Selene C Koo
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Kathleen M Schieffer
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kristy Lee
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA.,The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Ajay Gupta
- Department of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ruthann B Pfau
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA.,The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Eileen Stonerock
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Stephanie LaHaye
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - James Fitch
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Bhuvana A Setty
- Department of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ryan Roberts
- Department of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mark Ranalli
- Department of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Miriam R Conces
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pathology, The Ohio State University, Columbus, Ohio, USA
| | - Fang Bu
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Catherine E Cottrell
- Department of Pathology, The Ohio State University, Columbus, Ohio, USA.,The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
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6
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González-Arboleda AA, Fernandez N, García-Perdomo HA. Genitourinary Tract Tumors in Children: An Update. Curr Pediatr Rev 2022; 18:166-178. [PMID: 35021978 DOI: 10.2174/1573396318666220111143902] [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: 07/09/2021] [Revised: 09/17/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Genitourinary tract tumors in children are less common than in adults. Most of these tumors have different genetic backgrounds, clinical presentation, and oncologic behavior than their adult counterpart. As a result of low prevalence in children, some of the treatment approaches and recommendations are based on treatment experience in adult patients. However, thanks to scientific and technological development, survival rates have risen considerably. OBJECTIVE This paper presents a review of the principal features of the tumors involving the genitourinary tract in children and an update in genetic background, diagnosis, and treatment. METHODS A narrative review was performed on published literature about genitourinary tract tumors in pediatric patients. Papers presented in English and Spanish literature were reviewed. PubMed, Science Direct, and SciELO databases were used to collect information and present this article. RESULTS Kidney tumors are the most common type of genitourinary tumors in children. Among those, Wilms tumor represents the majority of cases and shows the successful work of clinical trial groups studying this tumor type. Other tumors involving the genitourinary tract in children include Rhabdomyosarcoma, Transitional cell carcinoma, Testicular, and Adrenal tumors. CONCLUSION Genitourinary tract tumors in children represent significant morbidity and economic burden, so awareness in early diagnosis represents improvement in treatment, clinical, and oncological outcomes.
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Affiliation(s)
| | - Nicolás Fernandez
- Division of Urology, Seattle Children´s Hospital, The University of Washington, Seattle, WA, USA
| | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, Universidad del Valle, Cali, Colombia.,Division of Urology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia
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Zhang X, Zhang H, Wang S, Gao Y, Liang L, Yang H. Prenatal diagnosis and postnatal management of congenital mesoblastic nephroma: A case report and literature review. Front Pediatr 2022; 10:1040304. [PMID: 36479286 PMCID: PMC9721394 DOI: 10.3389/fped.2022.1040304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Congenital mesoblastic nephroma (CMN) is a rare renal tumour in children, the most common kidney tumour in the neonatal period. It can be divided into three types, classical, cellular and mixed. CASE PRESENTATION A 31-year-old Chinese woman had no apparent foetal abnormality in regular prenatal care during the first and second trimesters. At 33 weeks of gestation, a solid mass in the right kidney was noted with echoes similar to liver and hypervascularity. It grew larger during late pregnancy. The infant was transferred to have a radical nephrectomy on the 9th day after birth. The postoperative histopathological result indicated classical CMN. CONCLUSION CMN could be detected prenatally, mainly during late pregnancy. The postnatal outcome is good.
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Affiliation(s)
- Xiaoxiao Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Huijing Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Shuang Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Yangxu Gao
- Department of Pediatric Surgery, Peking University First Hospital, Beijing, China
| | - Li Liang
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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