How well do you know your pediatric pathology? Here’s a good case to test your knowledge. Take a look at the question and photo, and then see if you can answer before scrolling down to see the answer and explanation.

A 3-year-old boy presents with a 7 cm, solitary abdominal mass which is surgically removed. Grossly, the mass is well-circumscribed, soft, and tan. A representative section is shown here.

case 21

What is the diagnosis?

A. Follicular lymphoma
B. Burkitt lymphoma
C. Wilms tumor
D. Neuroblastoma
E. Teratoma

 

 

 

 

(Scroll down for the answer)

 

 

 

 

 

 

 

The diagnosis in this case is Wilms tumor. Wilms tumor is the most common primary renal tumor of childhood, and the fourth most common pediatric malignancy overall. Most cases occur in patients under the age of 10, and most are unilateral.

Microscopically, the tumor usually consists of three components:

  1. A blastemal component (composed of sheets of small blue cells)
  2. An epithelial component (composed of tumor cells in abortive tubular or glomerular patterns)
  3. A stromal component (composed of fibrous or myxoid cells).

The prognosis for patients with Wilms tumor used to be very poor, with only 30% of patients achieving a cure. With new treatment, however, the cure rate has risen to 85%. Hurray!

If you liked this case, and want to test yourself with other unknown cases, here are some to try:

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