Wilms' tumor diagnostic study of choice

Wilms' tumor Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Wilms' Tumor from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Staging
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiography or Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Wilms' tumor diagnostic study of choice On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Wilms' tumor diagnostic study of choice All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Wilms' tumor diagnostic study of choice
CDC on Wilms' tumor diagnostic study of choice
Wilms' tumor diagnostic study of choice in the news
Blogs on Wilms' tumor diagnostic study of choice
Directions to Hospitals Treating Wilms' tumor
Risk calculators and risk factors for Wilms' tumor diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sargun Singh Walia M.B.B.S.[2]

Overview

Histology of the biopsy sample taken during surgery is the gold standard for the diagnosis of wilms tumor. Most of the tumors of the kidney have a favorable histology (90%).If anaplastic changes(3-7%) are found then the outcome is poor. If a case of wilms tumor is suspected in North America, then nephrectomy is done immediately. Contralateral kidney is also explored to check for disease and lymph node biopsies done. If tumor spill occurs then whole abdomen radiotherapy has to be done.

Diagnostic Study of Choice

Study of choice

• Histology of the biopsy sample taken during surgery is the gold standard for the diagnosis of wilms tumor.

Diagnostic results

The following result of histology is confirmatory of wilms tumor:

• Triphasic histology comprising -
  • Epithelial cells
  • Blastemal cells
  • Stromal cells
• Anaplastic changes
• Most of the tumors of the kidney have a favorable histology(90%).
• If anaplastic changes(3-7%) are found then the outcome is poor.

Wilms tumor histology The images show the characteristic three components: 1.Blastema component - Malignant small round (blue) cells ~ 2x the size of resting lymphocyte. 2.Epithelial component - Tubular structures/rosettes. 3.Stromal component - Loose paucicellular stroma with spindle cells. Source:By Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons

Sequence of Diagnostic Studies

The surgical examination and biopsy must be performed when:

• If a case of wilms tumor is suspected in North America, then nephrectomy is done immediately.
• Contralateral kidney is also explored to check for disease and lymph node biopsies done.
• Transcutaneous biopsy samples are almost never taken to prevent:
  • Tumor spill - If this occurs then whole abdomen radiotherapy has to be done.

•Tumor is seen in the upper pole of the kidney. •Well circumscribed lesion is seen with multiple necrotic, hemorrhagic and cystic changes. Source:By Abepathology [CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons