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__NOTOC__
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{{Wilms' tumor}}
{{Wilms' tumor}}
{{CMG}}; {{AE}} {{SC}}
{{CMG}}; {{AE}} {{SSW}}


==Overview==
==Overview==
18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT and biopsy may be helpful in the diagnosis of wilms' tumor.
Other diagnostic studies for Wilms tumor include [[PET scan]] and histology of biopsy samples taken.  


==Other Diagnostic Studies==
==Other Diagnostic Studies==
Other diagnostic studies for wilms tumor include:
Other diagnostic studies for Wilms tumor include:
* '''PET scan'''<ref name="pmid27001573">{{cite journal |vauthors=Hildebrandt MG, Gerke O, Baun C, Falch K, Hansen JA, Farahani ZA, Petersen H, Larsen LB, Duvnjak S, Buskevica I, Bektas S, Søe K, Jylling AM, Ewertz M, Alavi A, Høilund-Carlsen PF |title=[18F]Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET)/Computed Tomography (CT) in Suspected Recurrent Breast Cancer: A Prospective Comparative Study of Dual-Time-Point FDG-PET/CT, Contrast-Enhanced CT, and Bone Scintigraphy |journal=J. Clin. Oncol. |volume=34 |issue=16 |pages=1889–97 |date=June 2016 |pmid=27001573 |doi=10.1200/JCO.2015.63.5185 |url=}}</ref>
* '''PET scan'''<ref name="pmid27001573">{{cite journal |vauthors=Hildebrandt MG, Gerke O, Baun C, Falch K, Hansen JA, Farahani ZA, Petersen H, Larsen LB, Duvnjak S, Buskevica I, Bektas S, Søe K, Jylling AM, Ewertz M, Alavi A, Høilund-Carlsen PF |title=[18F]Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET)/Computed Tomography (CT) in Suspected Recurrent Breast Cancer: A Prospective Comparative Study of Dual-Time-Point FDG-PET/CT, Contrast-Enhanced CT, and Bone Scintigraphy |journal=J. Clin. Oncol. |volume=34 |issue=16 |pages=1889–97 |date=June 2016 |pmid=27001573 |doi=10.1200/JCO.2015.63.5185 |url=}}</ref>
** 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT.
** 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT.
** Wilms tumor is 18F-FDG avid, and 18F-FDG-PET-CT imaging adds clinically applicable information to conventional imaging.
** Wilms tumor is 18F-FDG avid, and 18F-FDG-PET-CT imaging adds clinically applicable information to conventional imaging.
** This may be particularly helpful in patients with bilateral disease or those receiving preoperative chemotherapy.
** This may be particularly helpful in patients with bilateral disease or those receiving [[Chemotherapy|preoperative chemotherapy]].
** 18F-FDG-PET-CT highlights FDG-avid areas in the tumor and metastases.  
** 18F-FDG-PET-CT highlights FDG-avid areas in the [[tumor]] and [[metastases]].  
** This corresponds to histologically confirmed active disease.
** This corresponds to histologically confirmed active disease.
* '''Biopsy'''
* '''Biopsy'''
** Histology of the biopsy sample taken during surgery is the gold standard for the diagnosis of wilms tumor.<ref name="pmid4728859">{{cite journal |vauthors=Tentzeris M, Fritz G |title=[Suction and irrigation drainage in the therapy of acute and chronic osteomyelitis] |language=German |journal=Zentralbl Chir |volume=98 |issue=21 |pages=771–4 |date=May 1973 |pmid=4728859 |doi= |url=}}</ref><ref name="pmid157385942">{{cite journal |vauthors=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |date=2004 |pmid=15738594 |doi= |url=}}</ref>
** Histology of the [[biopsy]] sample taken during surgery is the [[Gold standard (test)|gold standard]] for the diagnosis of Wilms tumor.<ref name="pmid4728859">{{cite journal |vauthors=Tentzeris M, Fritz G |title=[Suction and irrigation drainage in the therapy of acute and chronic osteomyelitis] |language=German |journal=Zentralbl Chir |volume=98 |issue=21 |pages=771–4 |date=May 1973 |pmid=4728859 |doi= |url=}}</ref><ref name="pmid157385942">{{cite journal |vauthors=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |date=2004 |pmid=15738594 |doi= |url=}}</ref>
** The following result of histology is confirmatory of wilms tumor:<ref name="pmid373364">{{cite journal |vauthors=Hansz J, Prazmowska-Owczarek B, Nowicka G |title=[Granulocyte adherence in advanced Hodgkin's disease and its dependence on antiproliferative drugs used] |language=Polish |journal=Acta Haematol Pol |volume=10 |issue=1 |pages=7–12 |date=1979 |pmid=373364 |doi= |url=}}</ref>
** The following result of histology is confirmatory of Wilms tumor:<ref name="pmid373364">{{cite journal |vauthors=Hansz J, Prazmowska-Owczarek B, Nowicka G |title=[Granulocyte adherence in advanced Hodgkin's disease and its dependence on antiproliferative drugs used] |language=Polish |journal=Acta Haematol Pol |volume=10 |issue=1 |pages=7–12 |date=1979 |pmid=373364 |doi= |url=}}</ref>
***Triphasic histology comprising -
***Triphasic histology comprising -
****[[Epithelial cells]]
****[[Epithelial cells]]
Line 22: Line 22:
****[[Stromal cell|Stromal cells]]
****[[Stromal cell|Stromal cells]]
***[[Anaplasia|Anaplastic]] changes
***[[Anaplasia|Anaplastic]] changes
***Most of the tumors of the kidney have a favorable histology(90%).
***Most of the tumors of the [[kidney]] have a favorable histology(90%).
***If [[Anaplasia|anaplastic]] changes(3-7%) are found then the outcome is poor.<ref name="pmid15738594">{{cite journal |vauthors=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |date=2004 |pmid=15738594 |doi= |url=}}</ref>   
***If [[Anaplasia|anaplastic]] changes(3-7%) are found then the outcome is poor.<ref name="pmid15738594">{{cite journal |vauthors=Stefanowicz J, Sierota D, Balcerska A, Stoba C |title=[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report] |language=Polish |journal=Med Wieku Rozwoj |volume=8 |issue=2 Pt 1 |pages=197–200 |date=2004 |pmid=15738594 |doi= |url=}}</ref> 
Biopsy


Biopsy or resection. In children with a renal mass that clinically appears to be stage I or stage II Wilms tumor, biopsy is not performed so that tumor cells are not spread during the [[biopsy]]. A biopsy would upstage such a patient to stage III. [[Nephrectomy]] (in North America) or [[chemotherapy]] (in Europe) is performed instead. Therefore, the diagnostic pathology is first seen when the nephrectomy specimen is examined.


Biopsy of a renal mass may be indicated if the mass is atypical by radiographic appearance for Wilms tumor, and the patient is not going to undergo immediate nephrectomy. Biopsy tissue from inoperable Wilms tumor obtained before chemotherapy may be used for histologic review and initial treatment decisions. The use of biopsy to determine histology in an inoperable tumor remains controversial because biopsy may cause local tumor spread. It is important to recognize that data from NWTS-4 and NWTS-5 (COG-Q9401/NCT00002611) have shown conclusively that, because of histologic heterogeneity of Wilms tumor, a significant number of patients have unfavorable histology that is missed during an upfront biopsy but revealed at the time of definitive surgery following chemotherapy.
[[File:Wilms tumour - very high mag.jpg|center|thumb|450x450px|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.  


If the initial imaging studies suggested a possible lesion on the contralateral kidney, the contralateral kidney is formally explored to rule out bilateral involvement. This is done before nephrectomy to exclude bilateral Wilms tumor.
'''Source''':By Nephron [CC BY-SA 3.0 (<nowiki>https://creativecommons.org/licenses/by-sa/3.0</nowiki>) or GFDL (<nowiki>http://www.gnu.org/copyleft/fdl.html</nowiki>)], from Wikimedia Commons<ref>https://librepathology.org/wiki/File:Wilms_tumour_-_low_mag.jpg#filelinks</ref>
]]


Biopsy is also controversial in patients with bilateral tumors because biopsy rarely detects anaplasia in bilateral Wilms tumor, and the incidence of bilateral tumors being other than Wilms is very low. The current COG study of bilateral Wilms tumor and of patients with unilateral Wilms tumor predisposed to developing bilateral tumors tries to avoid initial biopsy and mandates biopsy after 6 weeks of three-drug chemotherapy.
 
**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 [[Radiation therapy|radiotherapy]] has to be done. 
 
[[File:Wilms Tumour nephrectomy.jpg|center|thumb|405x405px|•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 (<nowiki>https://creativecommons.org/licenses/by-sa/4.0</nowiki>)], from Wikimedia Commons<ref>https://upload.wikimedia.org/wikipedia/commons/a/a8/Wilms_Tumour.jpg</ref>
]]  


==References==
==References==

Latest revision as of 17:29, 10 July 2018

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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

Other diagnostic studies for Wilms tumor include PET scan and histology of biopsy samples taken.

Other Diagnostic Studies

Other diagnostic studies for Wilms tumor include:

  • PET scan[1]
    • 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)-CT.
    • Wilms tumor is 18F-FDG avid, and 18F-FDG-PET-CT imaging adds clinically applicable information to conventional imaging.
    • This may be particularly helpful in patients with bilateral disease or those receiving preoperative chemotherapy.
    • 18F-FDG-PET-CT highlights FDG-avid areas in the tumor and metastases.
    • This corresponds to histologically confirmed active disease.
  • Biopsy


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[6]


    • 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[7]

 

References

  1. ↑ Hildebrandt MG, Gerke O, Baun C, Falch K, Hansen JA, Farahani ZA, Petersen H, Larsen LB, Duvnjak S, Buskevica I, Bektas S, Søe K, Jylling AM, Ewertz M, Alavi A, Høilund-Carlsen PF (June 2016). "[18F]Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET)/Computed Tomography (CT) in Suspected Recurrent Breast Cancer: A Prospective Comparative Study of Dual-Time-Point FDG-PET/CT, Contrast-Enhanced CT, and Bone Scintigraphy". J. Clin. Oncol. 34 (16): 1889–97. doi:10.1200/JCO.2015.63.5185. PMID 27001573.
  2. ↑ Tentzeris M, Fritz G (May 1973). "[Suction and irrigation drainage in the therapy of acute and chronic osteomyelitis]". Zentralbl Chir (in German). 98 (21): 771–4. PMID 4728859.
  3. ↑ Stefanowicz J, Sierota D, Balcerska A, Stoba C (2004). "[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report]". Med Wieku Rozwoj (in Polish). 8 (2 Pt 1): 197–200. PMID 15738594.
  4. ↑ Hansz J, Prazmowska-Owczarek B, Nowicka G (1979). "[Granulocyte adherence in advanced Hodgkin's disease and its dependence on antiproliferative drugs used]". Acta Haematol Pol (in Polish). 10 (1): 7–12. PMID 373364.
  5. ↑ Stefanowicz J, Sierota D, Balcerska A, Stoba C (2004). "[Wilms' tumour of unfavorable histology--results of treatment with the SIOP 93-01 protocol at the Gdańsk centre. Preliminary report]". Med Wieku Rozwoj (in Polish). 8 (2 Pt 1): 197–200. PMID 15738594.
  6. ↑ https://librepathology.org/wiki/File:Wilms_tumour_-_low_mag.jpg#filelinks
  7. ↑ https://upload.wikimedia.org/wikipedia/commons/a/a8/Wilms_Tumour.jpg

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