Molecular genetic evidence for common pathogenesis of childhood and adult Wilms' tumor

A case of Wilms' tumor in an adult is reported, showing, by restriction fragment length polymorphism analysis of somatic and tumor DNA, the loss of alleles from the short arm of chromosome 11. Loss of alleles in this region has previously been reported in childhood Wilms' tumor. The findings of this study indicate that adult Wilms' tumor and childhood Wilms' tumor may share a common pathogenic pathway. These results may also be useful in differentiating between Wilms' tumor and renal cell carcinoma or sarcoma in adults when the histologic findings are unclear.     

A case of Wilms' tumor and neuroblastoma of the kidneys in a child

Both kidneys in an 8-month-old boy contained tumours; Wilms' tumour was found in the right kidney and neuroblastoma in the left one. Nephroblastomatosis was observed in both kidneys. Multiple skin angiomas were observed after birth. Diagnosis of renal tumours was confirmed electron microscopically.     

Histochemical evidence of adenosine triphosphatase activity in glomus tumor--report of a case

A case of glomus tumor was studied by light and electron microscopic enzyme histochemistry. Histologically, this case was classified as glomangioma or vascular form of glomus tumor. The tumor cells had ultrastructural characteristics of smooth muscle cells such as large amount of thin filaments with dense bodies, basal lamina and numerous pinocytotic vesicles. Among the 3 membrane associated enzymes, namely alkaline phosphatase, adenosine triphosphatase (ATPase) and 5'nucleotidase, only ATPase was detectable in the cell membrane and pinocytotic vesicles. It is suggested that the ATPase activity of the tumor cells shows additional evidence of smooth muscle character of glomus tumor.     

Wilms' tumor in the adult--report of a case and review of the literature

Wilms' tumor is rare in adults. Its histology, grading and staging are identical to those in children. Investigators agree on a combined modality approach in the treatment of adult Wilms' tumor (AWT), but differ on how aggressive it should be. Some advocate adopting the current pediatric protocols which take into account tumor stage and grade. Others recommend using advanced disease regimens for all stages and grades. We report on an 18 year-old male with stage IV favorable histology Wilms' tumor. The patient underwent radical nephrectomy and received postoperative radiotherapy with intensive four-drug chemotherapy. He had one relapse after 12 months which was successfully treated with chemotherapy and radiotherapy. He remains in remission without relapses 36 months after the initial diagnosis. The genetics of Wilms' tumor has been well studied in children but is practically unknown in adults; karyotype and molecular genetic studies in this case were normal.     

A case of Mulibrey nanism with associated Wilms' tumor

The occurrence of a nephroblastoma in a 2–year-old girl with Mulibrey nanism is reported. As this tumor has also been reported in some other "mesodermal dysgenesis" syndromes, it seems probable that patients with this form of congenital disease run an abnormally high risk of Wilms' tumor.     

Characterization of glomeruli by immunohistochemistry and electron microscopy in a case of Wilms' tumor

A patient with an abdominal mass was found to have a Wilms' tumor. Light microscopic examination showed that, in addition to blastema, stroma, and tubules, the tumor contained an unusually large number of glomeruli. Glomerular basement membranes stained positively by immunohistochemistry for laminin, collagen type IV, fibronectin, and Goodpasture antigen. Staining for Goodpasture antigen was seen only after acid-urea treatment, which was similar to findings in fetal and infant glomeruli. Glomerular cells stained positively for actin, myosin, and desmin, but there was no staining for factor VIII or Ulex europaeus agglutinin I, indicating an absence of endothelial cells. These findings were supported by electron microscopy, which showed basement membrane material, visceral epithelial cells, and mesenchymal cells (presumably primitive mesangial cells) in glomeruli, but no patent capillaries or capillary endothelium. Hence, the glomeruli in this case of Wilms' tumor were immature and also showed aberrant glomerulogenesis.     

Wilms' tumor: a search for the critical lesion

A Wilms' tumor from a 12-month-old boy showed epithelial and mainly rhabdomyoblastic differentiation. In addition, the kidney contained foci of nephroblastomatosis, a lesion predisposing to the development of nephric tumors. Flow cytometry indicated that the tumor DNA content was in the diploid range with an increased S-phase. Chromosome studies of the cultured tumor cells showed a dominant pattern of 49,XY, +8,9qh+, +12, +12,18q+, without obvious deletion of 11p. A few cells showed additional losses, deletions, or structural rearrangements superimposed on the basic pattern, but no normal metaphases were observed. The DNA from the tumor was probed for several loci on 11p because variations of 11p (deletion or translocation) have been reported in roughly one third of Wilms' tumors, and the critical gene in Wilms' has been localized to 11p13. In this case, 11p genes maintained heterozygosity or showed no detectable alteration in gene dosage when compared with peripheral-blood DNA. Therefore, despite histologic indication of an underlying constitutional defect, no genomic lesion of 11p was identified.     

High-resolution genomic profiling of an adult Wilms' tumor: evidence for a pathogenesis distinct from corresponding pediatric tumors

Wilms’ tumor (WT), the most common kidney tumor among children, is characterized by a triphasic morphology consisting of blastemal, epithelial, and stromal components. Adult WT is a rare malignancy displaying similar histological features. We here present the first published high-resolution genomic analysis of a mixed-type adult WT. This revealed a more pronounced genetic complexity than usually observed in children with mixed-type WT. The majority of chromosomes displayed uniparental disomies, and microdeletions were present in genes with known importance for tumor formation (LRP1B, FHIT, and WWOX) or organogenesis (NEGR1 and ZFPM2), abnormalities not previously reported for pediatric WT. Our results indicate that adult WT is a biological entity distinct from the corresponding pediatric tumor type.     

Neural differentiation in Wilms' tumor

Immunoperoxidase studies using antibodies to neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), and S100 were used to confirm the presence of neural differentiation identified histologically in five cases of Wilms' Tumor. These observations invite reappraisal of Masson's proposed neuroectodermal histogenesis of Wilms' tumor because they are difficult to reconcile with the currently accepted metanephrogenic blastematous origin. They also provide a stimulus to examine the expression of neural markers during normal renal development and differentiation.     

Glomerulus-like structures in Wilms' tumor

Twenty-three cases of Wilms' tumour with numerous glomerulus-like structures (GLS) were studied. 74% children were admitted to the hospital with metastases or the latter developed within 2-3 months after a surgical operation. 5 out of the 8 children with bilateral Wilms' tumours had in the tumours an increased number of the GLS. There are some features which allow the GLS to be distinguished from the true renal corpuscles: the absence of capillaries and mesangium, structural polymorphism the presence of several pseudopapillae originating from different areas of the capsule. The possibility is shown to use these criteria in the differential diagnosis of renal sarcomas in children and sarcomatous variants of Wilms' tumour, in the determination of pseudocapsule infiltration and the degree of tumour tissue survival after the active therapy.     

Bilateral Wilms' tumor: a clinicopathologic review

Bilateral Wilms' tumor occurs at a younger age than unilateral disease. While it generally has a good prognosis, it presents a therapeutic dilemma to balance curative surgical resection with preservation of renal tissue. A 15 year review of bilateral Wilms' tumors diagnosed at Princess Margaret Hospital was undertaken. Of 46 Wilms' tumor cases, eight were designated bilateral by diagnostic imaging (median age 1.1 years compared with 3.5 years for unilateral tumors). The surgical management entailed primary nephrectomy with contralateral biopsy in two patients, and bilateral biopsy and delayed resection in all remaining surviving patients (one patient died of perioperative complications). Seven patients had localized disease (stage I/II) and the six surviving patients received chemotherapy with vincristine and actinomycin; no patient received radiotherapy. All are alive and well (median follow-up 5.1 years). The remaining patient presented with pulmonary metastases and died of disease progression. Pathologic review revealed that four patients had truly bilateral disease demonstrable by histology, three had unilateral Wilms' tumor with contralateral nephrogenic rests, and in one patient the biopsies of the contralateral kidney showed neither tumor nor nephrogenic rests. In most cases pathological material was subject to external review. Follow-up demonstrates excellent renal function with compensatory hypertrophy in the remaining renal tissue. Conservative surgery and simple out-patient based, low toxicity chemotherapy is curative in most patients.     

The cytogenetics of Wilms' tumor

A close association has been demonstrated between the congenital deletion 11p13 and predisposition to Wilms' tumor. Recent cytogenetic studies on Wilms' tumor cells from normal children strongly suggests that somatic changes in the short arm of chromosome #11 play an important role in the development of this tumor. The application of improved cytogenetic techniques coupled with molecular biologic analysis may help resolve questions regarding the requirement of additional changes (to alterations of 11p13) in order to evoke complete transformation leading to malignancy.