Nephroblastic Neoplasms

So-called 'adenosarcoma' of the kidney a novel adult renal tumor with a cystic appearance

We describe a novel cystic renal tumor consisting of benign epithelial and malignant stromal components in a 56-year-old woman who was admitted to hospital with macroscopic hematuria. Enhanced computed tomography revealed a multilocular 3.4 × 2.7-cm tumor in the center of the left kidney. After total left nephrectomy, the excised tumor appeared extensively cystic with a well defined border on the cut surface. Histologically, the tumor was composed of biphasic a benign epithelial lining on tubules or cysts with a typically hobnailed appearance, and anaplastic sarcomatous stroma with frequent mitosis. Periepithelial cuffing of the sarcoma cells was evident without an epithelial-stromal transition. Carcinomatous nests, blastemic elements, ovarian-like stroma or differentiated mesenchyme were not evident in the stroma. The epithelial cells were reactive with cytokeratins, epithelial membrane antigen (EMA), vimentin and transducin-like enhancer protein 1 (TLE1). Stromal cells were reactive with vimentin, CD99 and TLE1, partly reactive with CD34 and CD10, and non-reactive with cytokeratins, EMA, Wilm's tumor protein (WT-1), estrogen receptor (ER), progesterone receptor (PgR), CD57, HMB45 or Bcl2. SYT-SSX fusion gene was not detected with reverse transcription polymerase chain reaction. Because these findings did not coincide with established descriptions of cystic renal neoplasms, we preferred the term, 'adenosarcoma'. This could become a new classification for adult cystic renal tumors.

Management of fetal tumors

OBJECTIVE

To review the diagnosis, management, and treatment options of tumors presenting during fetal development.

METHODS

Recognized textbooks and peer-reviewed literature (from the years 1985-2006) were summarized for the most common information on fetal tumors.

RESULTS

Fetal tumors are rare, with a usual prevalence of less than 1 in 10,000 live births. The list of fetal tumors reviewed includes tumors involving multiple sites, such as teratoma, lymphangioma, and hemangioma, and tumors located specifically in organs such the liver, adrenal gland, kidney, and placenta.

CONCLUSIONS

Prenatal diagnosis, surveillance, and treatment of fetal tumors is limited to case reports, small series, and single-institution experience.