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Eur J Pediatr Surg
DOI: 10.1055/s-0044-1791846
Original Article

Pathological Insights into Non-Neoplastic Renal Parenchyma in Wilms Tumor: Implications for Nephron-Sparing Surgery

Mingchuan Huang   *
1   Department of Pediatric Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Man Shu   *
2   Department of Pathology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Zhe Xu   *
1   Department of Pediatric Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Lin Wang
3   Guangzhou KingMed Diagnostics Laboratory Group Co Ltd, Guangzhou, People's Republic of China
,
Longshan Liu
4   Organ Transplant Center, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Juncheng Liu
1   Department of Pediatric Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Huanxi Zhang
4   Organ Transplant Center, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Shicong Yang   #
2   Department of Pathology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Changxi Wang   #
4   Organ Transplant Center, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
5   Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
6   Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
,
Pengfei Gao   #
1   Department of Pediatric Surgery, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
4   Organ Transplant Center, Sun Yat-sen University First Affiliated Hospital, Guangzhou, People's Republic of China
› Author Affiliations Funding This study was supported by National Natural Science Foundation of China (81870511, 82170770), Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology (2017B030314018, 2020B1212060026), Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation, 2020A0505020003), Science and Technology Planning Project of Guangzhou City (201903010058, 202201011318), Major Clinical Technology Project of Guangzhou City (2023P-ZD15), Elite Talent Project of Guangdong Province (R09002), Natural Science Foundation of Guangdong Province (22140500001368) and Medical Science and Technology Research Foundation of Guangdong Province (A2024298).
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Abstract

Introduction This study aimed to evaluate the non-neoplastic renal parenchyma in Wilms tumor (WT) and investigate its impact on nephron-sparing surgery (NSS).

Materials and Methods The non-neoplastic renal parenchyma of WT patients was prospectively collected for pathological examination. The histology of non-neoplastic renal parenchyma was assessed from two perspectives: nephrogenic rests (NRs) and nephrons.

Results A total of 46 non-neoplastic renal parenchyma specimens were collected from 42 WT patients. The surgeons assessed the median proportion of non-neoplastic renal parenchyma as 30%, whereas using ellipsoid volume, it was calculated to be 27%. The Youden index of surgeons' assessment peaked at a 15% proportion of non-neoplastic renal parenchyma. The bilateral WT (BWT) group and NSS group exhibited significant differences compared with the unilateral WT group and radical nephrectomy group, respectively, with the BWT group showing a tendency toward thickened basement membrane.

Conclusion The presence of NRs and endogenous nephron alternations should be given due attention in WT. The probability of abnormalities is low when the proportion of non-neoplastic renal parenchyma exceeds 15%, providing pathological support for expanding the adaptation of NSS.

Keywords

Wilms tumor - non-neoplastic renal parenchyma - nephrogenic rests - nephron-sparing surgery

* These authors have contributed equally to this work and share first authorship.


# Shicong Yang, Changxi Wang and Pengfei Gao serve as co-corresponding authors. The first corresponding author is Pengfei Gao.




Publication History

Received: 21 May 2024

Accepted: 25 September 2024

Article published online:
18 October 2024

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  • References

  • 1 Williamson KA, Van Heyningen V. Towards an understanding of Wilms' tumour. Int J Exp Pathol 1994; 75 (03) 147-155
    PubMedGoogle Scholar
  • 2 Vujanić GM, Gessler M, Ooms AHAG. et al; International Society of Paediatric Oncology–Renal Tumour Study Group (SIOP–RTSG). The UMBRELLA SIOP-RTSG 2016 Wilms tumour pathology and molecular biology protocol. Nat Rev Urol 2018; 15 (11) 693-701
    CrossrefPubMedGoogle Scholar
  • 3 Vujanić GM, Apps JR, Moroz V. et al. Nephrogenic rests in Wilms tumors treated with preoperative chemotherapy: The UK SIOP Wilms Tumor 2001 Trial experience. Pediatr Blood Cancer 2017; 64 (11) e26547
    CrossrefPubMedGoogle Scholar
  • 4 Thorner P, McGraw M, Weitzman S, Balfe JW, Klein M, Baumal R. Wilms' tumor and glomerular disease. Occurrence with features of membranoproliferative glomerulonephritis and secondary focal, segmental glomerulosclerosis. Arch Pathol Lab Med 1984; 108 (02) 141-146
    PubMedGoogle Scholar
  • 5 Rudin C, Pritchard J, Fernando ON, Duffy PG, Trompeter RS. Renal transplantation in the management of bilateral Wilms' tumour (BWT) and of Denys-Drash syndrome (DDS). Nephrol Dial Transplant 1998; 13 (06) 1506-1510
    CrossrefPubMedGoogle Scholar
  • 6 Fuchs J, Kienecker K, Furtwängler R. et al. Surgical aspects in the treatment of patients with unilateral Wilms tumor: a report from the SIOP 93-01/German Society of Pediatric Oncology and Hematology. Ann Surg 2009; 249 (04) 666-671
    CrossrefPubMedGoogle Scholar
  • 7 Cox S, Büyükünal C, Millar AJW. Surgery for the complex Wilms tumour. Pediatr Surg Int 2020; 36 (02) 113-127
    CrossrefPubMedGoogle Scholar
  • 8 Mrad C, Coulomb-Lhermine A, Tabone MD, Ulinski T, Audry G, Irtan S. Evaluation of the nephron-sparing surgery formula in Wilms tumors. Pediatr Blood Cancer 2020; 67 (12) e28661
    CrossrefPubMedGoogle Scholar
  • 9 Cozzi F, Zani A, Schiavetti A. et al. Compensatory renal growth in children with unilateral renal tumor treated by nephron-sparing surgery or nephrectomy. Eur J Pediatr Surg 2007; 17 (06) 382-386
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Davidoff AM. Wilms' tumor. Curr Opin Pediatr 2009; 21 (03) 357-364
    CrossrefPubMedGoogle Scholar
  • 11 Knijnenburg SL, Jaspers MW, van der Pal HJ. et al. Renal dysfunction and elevated blood pressure in long-term childhood cancer survivors. Clin J Am Soc Nephrol 2012; 7 (09) 1416-1427
    CrossrefPubMedGoogle Scholar
  • 12 Mulder RL, Knijnenburg SL, Geskus RB. et al. Glomerular function time trends in long-term survivors of childhood cancer: a longitudinal study. Cancer Epidemiol Biomarkers Prev 2013; 22 (10) 1736-1746
    CrossrefPubMedGoogle Scholar
  • 13 Beckwith JB, Kiviat NB, Bonadio JF. Nephrogenic rests, nephroblastomatosis, and the pathogenesis of Wilms' tumor. Pediatr Pathol 1990; 10 (1-2): 1-36
    CrossrefPubMedGoogle Scholar
  • 14 Moch H, Humphrey PA, Ulbriglit TM. et al. WHO Classification of Tumours of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2016: 48-53
    Google Scholar
  • 15 Bijol V, Mendez GP, Hurwitz S, Rennke HG, Nosé V. Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure. Am J Surg Pathol 2006; 30 (05) 575-584
    CrossrefPubMedGoogle Scholar
  • 16 Lange J, Peterson SM, Takashima JR. et al. Risk factors for end stage renal disease in non-WT1-syndromic Wilms tumor. J Urol 2011; 186 (02) 378-386
    CrossrefPubMedGoogle Scholar
  • 17 Zuppan C. Role of electron microscopy in the diagnosis of nonneoplastic renal disease in children. Ultrastruct Pathol 2011; 35 (06) 240-244
    CrossrefPubMedGoogle Scholar
  • 18 Alpers CE, Cotran RS. Neoplasia and glomerular injury. Kidney Int 1986; 30 (04) 465-473
    CrossrefPubMedGoogle Scholar
  • 19 Burstein DM, Korbet SM, Schwartz MM. Membranous glomerulonephritis and malignancy. Am J Kidney Dis 1993; 22 (01) 5-10
    CrossrefPubMedGoogle Scholar
  • 20 Wagrowska-Danilewicz M, Danilewicz M. Current position of electron microscopy in the diagnosis of glomerular diseases. Pol J Pathol 2007; 58 (02) 87-92
    PubMedGoogle Scholar
  • 21 van den Heuvel-Eibrink MM, Hol JA, Pritchard-Jones K. et al; International Society of Paediatric Oncology — Renal Tumour Study Group (SIOP–RTSG). Position paper: Rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol 2017; 14 (12) 743-752
    CrossrefPubMedGoogle Scholar
  • 22 Wilde JC, Aronson DC, Sznajder B. et al. Nephron sparing surgery (NSS) for unilateral Wilms tumor (UWT): the SIOP 2001 experience. Pediatr Blood Cancer 2014; 61 (12) 2175-2179
    CrossrefPubMedGoogle Scholar
  • 23 Wang X, Liu Q, Kong W. et al. Pathologic analysis of non-neoplastic parenchyma in renal cell carcinoma: a comprehensive observation in radical nephrectomy specimens. BMC Cancer 2017; 17 (01) 900
    CrossrefPubMedGoogle Scholar
  • 24 Bonsib SM, Pei Y. The non-neoplastic kidney in tumor nephrectomy specimens: what can it show and what is important?. Adv Anat Pathol 2010; 17 (04) 235-250
    CrossrefPubMedGoogle Scholar
  • 25 Truong LD, Shen SS, Park MH, Krishnan B. Diagnosing nonneoplastic lesions in nephrectomy specimens. Arch Pathol Lab Med 2009; 133 (02) 189-200
    CrossrefPubMedGoogle Scholar
  • 26 Dernell C, Bhasin B, Iczkowski KA, Gallan AJ. Characterization of the peritumoral atrophic band and nonneoplastic renal parenchyma in radical nephrectomy Specimens. Am J Clin Pathol 2021; 156 (05) 913-919
    CrossrefPubMedGoogle Scholar
  • 27 Henriksen KJ, Meehan SM, Chang A. Non-neoplastic renal diseases are often unrecognized in adult tumor nephrectomy specimens: a review of 246 cases. Am J Surg Pathol 2007; 31 (11) 1703-1708
    CrossrefPubMedGoogle Scholar
  • 28 Chang A, Finelli A, Berns JS, Rosner M. Chronic kidney disease in patients with renal cell carcinoma. Adv Chronic Kidney Dis 2014; 21 (01) 91-95
    CrossrefPubMedGoogle Scholar