Wilms’ Tumour – Histology and Differential Diagnosis

Wilms’ tumour (WT) is the most common paediatric renal tumour, which can present as a single nodule, as multifocal unilateral lesions or as bilateral tumours. Typically, WT comprises three histological components namely blastemal, epithelial and stromal. The proportion and the degree of maturation o...

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description Wilms’ tumour (WT) is the most common paediatric renal tumour, which can present as a single nodule, as multifocal unilateral lesions or as bilateral tumours. Typically, WT comprises three histological components namely blastemal, epithelial and stromal. The proportion and the degree of maturation of these components vary significantly, making the histological appearance of each tumour unique. Classical triphasic WT rarely presents diagnostic difficulty for pathologists, but when only one component is present, especially in a small biopsy specimen, the differential diagnosis may include renal cell carcinoma, metanephric adenoma and hyperplastic nephrogenic rest for epithelial elements and clear cell sarcoma of the kidney, mesoblastic nephroma and synovial sarcoma for stromal elements. Pure blastemal-type WT may be difficult to distinguish from other embryonal ‘small round blue cell tumours’, including neuroblastoma, primitive neuroectodermal tumour/Ewing sarcoma, desmoplastic small round cell tumour and lymphoma. All the three components, though usually blastema, can become anaplastic, leading to the diagnosis of either focal or diffuse anaplasia. WT with diffuse anaplasia and WT with blastemal predominance (after preoperative che¬motherapy) are regarded as high-risk tumours and require more aggressive treatment. Careful assessment of the tumour and the normal kidney is critical for accurate subtyping and staging of WT, which is the basis for post-operative treatment. In addition, the identification and correct interpretation of nephrogenic rests may affect prognosis and management. Histological distinction between WT and nephrogenic rest is not always possible based on morphology alone, and implementation of new molecular genetic tools may aid in this regard. Other molecular genetic signatures of WT, such as P53 mutation and MYCN dysregulation, may provide future additional prognostic and therapeutic information.
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spelling doab-20.500.12854ir-1382252024-05-24T00:31:28Z Wilms’ Tumour – Histology and Differential Diagnosis nephrogenic rest Wilms’ tumour MJR Wilms’ tumour (WT) is the most common paediatric renal tumour, which can present as a single nodule, as multifocal unilateral lesions or as bilateral tumours. Typically, WT comprises three histological components namely blastemal, epithelial and stromal. The proportion and the degree of maturation of these components vary significantly, making the histological appearance of each tumour unique. Classical triphasic WT rarely presents diagnostic difficulty for pathologists, but when only one component is present, especially in a small biopsy specimen, the differential diagnosis may include renal cell carcinoma, metanephric adenoma and hyperplastic nephrogenic rest for epithelial elements and clear cell sarcoma of the kidney, mesoblastic nephroma and synovial sarcoma for stromal elements. Pure blastemal-type WT may be difficult to distinguish from other embryonal ‘small round blue cell tumours’, including neuroblastoma, primitive neuroectodermal tumour/Ewing sarcoma, desmoplastic small round cell tumour and lymphoma. All the three components, though usually blastema, can become anaplastic, leading to the diagnosis of either focal or diffuse anaplasia. WT with diffuse anaplasia and WT with blastemal predominance (after preoperative che¬motherapy) are regarded as high-risk tumours and require more aggressive treatment. Careful assessment of the tumour and the normal kidney is critical for accurate subtyping and staging of WT, which is the basis for post-operative treatment. In addition, the identification and correct interpretation of nephrogenic rests may affect prognosis and management. Histological distinction between WT and nephrogenic rest is not always possible based on morphology alone, and implementation of new molecular genetic tools may aid in this regard. Other molecular genetic signatures of WT, such as P53 mutation and MYCN dysregulation, may provide future additional prognostic and therapeutic information. Published 2024-05-24T00:31:24Z 2024-05-24T00:31:24Z 2016-03-23 chapter 978-0-9944381-1-9 https://directory.doabooks.org/handle/20.500.12854/138225 eng image/jpeg Attribution-NonCommercial-NoDerivatives 4.0 International https://exonpublications.com/index.php/exon/article/view/96 Exon Publications Wilms Tumor 10.15586/codon.wt.2016.ch1 10.15586/codon.wt.2016.ch1 2d6001a3-9e06-4979-bf02-6974e313eb24 be2904b4-c51f-4613-9ba6-25343b010396 978-0-9944381-1-9 3-21 Brisbane(AU) open access
spellingShingle nephrogenic rest
Wilms’ tumour
MJR
Wilms’ Tumour – Histology and Differential Diagnosis
title Wilms’ Tumour – Histology and Differential Diagnosis
title_full Wilms’ Tumour – Histology and Differential Diagnosis
title_fullStr Wilms’ Tumour – Histology and Differential Diagnosis
title_full_unstemmed Wilms’ Tumour – Histology and Differential Diagnosis
title_short Wilms’ Tumour – Histology and Differential Diagnosis
title_sort wilms tumour histology and differential diagnosis
topic nephrogenic rest
Wilms’ tumour
MJR
topic_facet nephrogenic rest
Wilms’ tumour
MJR
url https://directory.doabooks.org/handle/20.500.12854/138225