肾母细胞瘤:成人患者的意外诊断。

Garrett J Chan, Bradley A Stohr, Adeboye O Osunkoya, Nicole A Croom, Soo-Jin Cho, Ronald Balassanian, Vivek Charu, Gregory R Bean, Emily Chan
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引用次数: 0

摘要

上下文。--:成年患者的肾母细胞瘤(WT)很罕见,历来是一个诊断和治疗难题,文献中可用的数据有限。目标。--:提供成年WT患者多机构队列的详细诊断特征、分子谱和患者结果。设计。--:我们确定并回顾性检查了4例成人WT病例。结果。--:两名患者表现为转移性疾病,并通过肾肿块的细针抽吸进行诊断。抽吸物包括形成管状玫瑰花结和坏死的恶性原始上皮样细胞,细胞块显示为三相组织学。在剩下的2例中,患者表现为局限性疾病,并在切除时得到诊断,两名患者都表现出上皮为主的形态。所有病例的肿瘤细胞PAX8和WT1免疫组织化学均呈斑片状可变阳性。下一代测序确定了先前报道的儿科WT中3/4例的改变,包括ASXL1(2/4)、WT1(1/4)和TERT启动子(1/4)的突变,以及1q增益(1/4);1例无改变。三名患者接受了儿科化疗方案的治疗;在随访期间(26-60个月),1例患者死于疾病。结论。--:WT在成人中是一种意外且难以诊断的实体,当面临原始出现的肾脏或转移性肿瘤时应予以考虑。分子测试可能有助于排除其他可能性,但可能并不敏感或特异,因为在WT中报告了相对大量的驱动突变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Wilms Tumor: An Unexpected Diagnosis in Adult Patients.

Context.—: Wilms tumor (WT) in adult patients is rare and has historically been a diagnostic and therapeutic conundrum, with limited data available in the literature.

Objective.—: To provide detailed diagnostic features, molecular profiling, and patient outcomes in a multi-institutional cohort of adult WT patients.

Design.—: We identified and retrospectively examined 4 adult WT cases.

Results.—: Two patients presented with metastatic disease, and diagnoses were made on fine-needle aspiration of their renal masses. The aspirates included malignant primitive-appearing epithelioid cells forming tubular rosettes and necrosis, and cell blocks demonstrated triphasic histology. In the remaining 2 cases, patients presented with localized disease and received a diagnosis on resection, with both patients demonstrating an epithelial-predominant morphology. Tumor cells in all cases were patchy variable positive for PAX8 and WT1 immunohistochemistry. Next-generation sequencing identified alterations previously reported in pediatric WT in 3 of 4 cases, including mutations in ASXL1 (2 of 4), WT1 (1 of 4), and the TERT promoter (1 of 4), as well as 1q gains (1 of 4); 1 case showed no alterations. Three patients were treated with pediatric chemotherapy protocols; during follow-up (range, 26-60 months), 1 patient died of disease.

Conclusions.—: WT is an unexpected and difficult entity to diagnose in adults and should be considered when faced with a primitive-appearing renal or metastatic tumor. Molecular testing may help exclude other possibilities but may not be sensitive or specific because of the relatively large number of driver mutations reported in WT.

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