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Best Cases from the AFIP

Anaplastic Wilms Tumor: Radiologic and Pathologic Findings¹

¹ From the Department of Radiology, Emory University Hospital, Atlanta, Ga (T.M.A.); and the Departments of Pathology (R.Y.) and Radiology (K.W.M.), Children’s Healthcare of Atlanta at Scottish Rite. Received March 15, 2004; revision requested April 14 and received June 25; accepted July 27. All authors have no financial relationships to disclose. Address correspondence to T.M.A., 211 E Ohio St, Unit 1514, Chicago, IL 60611 (e-mail: taquisto@yahoo.com).

View larger version (118K): [in a new window]   Figure 1a.  (a) Axial contrast material-enhanced CT image obtained through the abdomen shows a large, lobulated, heterogeneously attenuating mass of the posterolateral right kidney with involvement of the subcapsular and perinephric spaces. The areas of lower attenuation suggest the presence of hemorrhage and necrosis. (b, c) Sequential axial CT images from the same data acquisition as a show distortion of the renal collecting system from mass effect without definite invasion. There is normal enhancement of the inferior vena cava (IVC).

View larger version (120K): [in a new window]   Figure 1b.  (a) Axial contrast material-enhanced CT image obtained through the abdomen shows a large, lobulated, heterogeneously attenuating mass of the posterolateral right kidney with involvement of the subcapsular and perinephric spaces. The areas of lower attenuation suggest the presence of hemorrhage and necrosis. (b, c) Sequential axial CT images from the same data acquisition as a show distortion of the renal collecting system from mass effect without definite invasion. There is normal enhancement of the inferior vena cava (IVC).

View larger version (107K): [in a new window]   Figure 1c.  (a) Axial contrast material-enhanced CT image obtained through the abdomen shows a large, lobulated, heterogeneously attenuating mass of the posterolateral right kidney with involvement of the subcapsular and perinephric spaces. The areas of lower attenuation suggest the presence of hemorrhage and necrosis. (b, c) Sequential axial CT images from the same data acquisition as a show distortion of the renal collecting system from mass effect without definite invasion. There is normal enhancement of the inferior vena cava (IVC).

View larger version (145K): [in a new window]   Figure 2.  Sagittal static US image obtained through the inferior right kidney shows the large, predominantly hyperechoic mass, which is located in the posteroinferior part of the kidney and contains areas of heterogeneous echotexture.

View larger version (103K): [in a new window]   Figure 3.  Photograph of the gross specimen from right radical nephrectomy shows the large mass extending from the posterior aspect of the kidney. The tumor tissue is pink and friable and extends into the adjacent retroperitoneal soft tissue. There is no evidence of invasion of the renal pelvis or hilar vessels.

View larger version (194K): [in a new window]   Figure 4a.  (a) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a section through the mass shows multiple neoplastic cells, which are oval to irregular in shape and have hyperchromatic nuclei. The tumor cells are composed predominantly of blastemal and tubular elements. (b) Photomicrograph obtained at a higher power (original magnification, x200; hematoxylin-eosin stain) shows areas of abundant mitoses and apoptotic figures, findings consistent with anaplasia. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a different section through the mass shows small islands of tumor tissue within and beyond a thin fibrous tumor capsule.

View larger version (174K): [in a new window]   Figure 4b.  (a) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a section through the mass shows multiple neoplastic cells, which are oval to irregular in shape and have hyperchromatic nuclei. The tumor cells are composed predominantly of blastemal and tubular elements. (b) Photomicrograph obtained at a higher power (original magnification, x200; hematoxylin-eosin stain) shows areas of abundant mitoses and apoptotic figures, findings consistent with anaplasia. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a different section through the mass shows small islands of tumor tissue within and beyond a thin fibrous tumor capsule.

View larger version (184K): [in a new window]   Figure 4c.  (a) Photomicrograph (original magnification, x100; hematoxylin-eosin stain) of a section through the mass shows multiple neoplastic cells, which are oval to irregular in shape and have hyperchromatic nuclei. The tumor cells are composed predominantly of blastemal and tubular elements. (b) Photomicrograph obtained at a higher power (original magnification, x200; hematoxylin-eosin stain) shows areas of abundant mitoses and apoptotic figures, findings consistent with anaplasia. (c) Photomicrograph (original magnification, x40; hematoxylin-eosin stain) of a different section through the mass shows small islands of tumor tissue within and beyond a thin fibrous tumor capsule.