Fang Yiwei,Song Hongcheng.Differential diagnosis of different pathologic types of renal tumors in children[J].Journal of Clinical Pediatric Surgery,2022,21(12):1106-1110.[doi:10.3760/cma.j.cn101785-202205056-002]
儿童不同病理类型肾脏肿瘤的鉴别与诊断
- Title:
- Differential diagnosis of different pathologic types of renal tumors in children
- Keywords:
- Kidney Neoplasms; Pathology; Diagnosis; Differential; Child
- 摘要:
- 儿童肾脏肿瘤可分为肾母细胞瘤[nephroblastoma,又称威尔姆斯瘤(Wilms tumors,WT)]与非肾母细胞瘤肾肿瘤(non-Wilms renal tumors,NWRTs)两大类。WT为恶性肿瘤,早期文献报道占儿童肾脏肿瘤的90%~95%。NWRTs病理类型具有异质性,部分为良性肿瘤。儿童肾肿瘤的治疗方案和治疗结局多样,不同病理类型患儿预后差异显著,精准诊断尤为重要。术前推断肾脏肿瘤病理类型,可辅助选择合理的手术方式;而术后明确诊断肾脏肿瘤病理类型,是后续治疗的依据。本文重点论述儿童不同病理类型肾脏肿瘤的鉴别诊断,以期指导临床合理选择治疗方式,改善患儿预后。
- Abstract:
- Renal tumors in children can be classified into two categories of nephroblastoma and non-Wilms renal tumors (NWRTs).Among them,nephroblastoma is a malignant tumor accounting for about 90%-95% of pediatric renal tumors reported in early literature.The pathological types of NWRTs are heterogeneous and some of them were benign.Treatment options and clinical outcomes of pediatric renal tumors are diverse and the prognosis is significantly different with different pathological types.A precise diagnosis is particularly important.Preoperative clinical inference of the pathological type of renal tumor can assist in selecting a reasonable surgical approach and pathological type of postoperative renal tumor is a gold standard for subsequent treatment.Therefore this review focused upon the differential diagnosis of renal tumors in children with different pathological types to guide the selection of reasonable treatments and improve the prognosis of children.
参考文献/References:
[1] van den Heuvel-Eibrink MM,Hol JA,Pritchard-Jones K,et al.Position paper:rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol[J].Nat Rev Urol,2017,14(12):743-752.DOI:10.1038/nrurol.2017.163.
[2] Bozlu G,??tak E?.Evaluation of renal tumors in children[J].Turk J Urol,2018,44(3):268-273.DOI:10.5152/tud.2018.70120.
[3] 中华医学会小儿外科学分会泌尿外科学组.儿童肾母细胞瘤诊疗专家共识[J].中华小儿外科杂志,2020,41(7):585-590.DOI:10.3760/cma.j.cn421158-20190805-00479.Group of Urological Surgery,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Pediatric Nephroblastoma[J].Chin J Pediatr Surg,2020,41(7):585-590.DOI:10.3760/cma.j.cn421158-20190805-00479.
[4] Saula PW,Hadley GP.Pediatric non-Wilms’ renal tumors:a third world experience[J].World J Surg,2012,36(3):565-572.DOI:10.1007/s00268-011-1410-2.
[5] ünal E,Yilmaz E,?zcan A,et al.Twenty children with non-Wilms renal tumors from a reference center in Central Anatolia,Turkey[J].Turk J Med Sci,2020,50(1):18-24.DOI:10.3906/sag-1902-106.
[6] Roy P,van Peer SE,de Witte MM,et al.Characteristics and outcome of children with renal tumors in the Netherlands:the first five-year’s experience of national centralization[J].PLoS One,2022,17(1):e0261729.DOI:10.1371/journal.pone.0261729.
[7] Fang YW,Song HC,Sun N,et al.Non-Wilms’ renal tumors in children:experience with 139 cases treated at a single center[J].BMC Urol,2022,22(1):89.DOI:10.1186/s12894-022-01042-3.
[8] 王冠男,孙宁,张潍平,等.儿童肾透明细胞肉瘤诊治分析[J].中华小儿外科杂志,2018,39(9):670-675.DOI:10.3760/cma.j.issn.0253-3006.2018.09.007.Wang GN,Sun N,Zhang WP,et al.Diagnosis and treatment of clear cell sarcoma of kidney in children[J].Chin J Pediatr Surg,2018,39(9):670-675.DOI:10.3760/cma.j.issn.0253-3006.2018.09.007.
[9] 焦丽丽,宋宏程,孙宁,等.婴幼儿肾脏恶性横纹肌样瘤诊治分析[J].临床小儿外科杂志,2016,15(4):368-370.DOI:10.3969/j.issn.1671-6353.2016.04.017.Jiao LL,Song HC,Sun N,et al.Diagnosis and treatment of malignant rhabdoid tumor of the kidney in infants and toddlers[J].J Clin Ped Sur,2016,15(4):368-370.DOI:10.3969/j.issn.1671-6353.2016.04.017.
[10] Adeniran AJ,Shuch B,Humphrey PA.Hereditary renal cell carcinoma syndromes:clinical,pathologic,and genetic features[J].Am J Surg Pathol,2015,39(12):e1-e18.DOI:10.1097/PAS.0000000000000562.
[11] Luithle T,Szavay P,Furtw?ngler R,et al.Treatment of cystic nephroma and cystic partially differentiated nephroblastoma-a report from the SIOP/GPOH study group[J].J Urol,2007,177(1):294-296.DOI:10.1016/j.juro.2006.09.011.
[12] Gooskens SL,Houwing ME,Vujanic GM,et al.Congenital mesoblastic nephroma 50 years after its recognition:a narrative review[J].Pediatr Blood Cancer,2017,64(7):e26437.DOI:10.1002/pbc.26437.
[13] Zhu K,Yang M,Zheng Y,et al.Coexisting differentiated neuroblastoma and ossifying renal tumor of infancy in a patient[J].Fetal Pediatr Pathol,2015,34(1):14-17.DOI:10.3109/15513815.2014.947542.
[14] van den Heuvel-Eibrink MM,van Tinteren H,Rehorst H,et al.Malignant rhabdoid tumours of the kidney (MRTKs),registered on recent SIOP protocols from 1993 to 2005:a report of the SIOP renal tumour study group[J].Pediatr Blood Cancer,2011,56(5):733-737.DOI:10.1002/pbc.22922.
[15] Tomlinson GE,Breslow NE,Dome J,et al.Rhabdoid tumor of the kidney in the National Wilms’ Tumor Study:age at diagnosis as a prognostic factor[J].J Clin Oncol,2005,23(30):7641-7645.DOI:10.1200/JCO.2004.00.8110.
[16] Silberstein J,Grabowski J,Saltzstein SL,et al.Renal cell carcinoma in the pediatric population:results from the California Cancer Registry[J].Pediatr Blood Cancer,2009,52(2):237-241.DOI:10.1002/pbc.21779.
[17] Aghili M,Rafiei E,Mojahed M,et al.Renal primitive neuroectodermal tumor:does age at diagnosis impact outcomes?[J].Rare Tumors,2012,4(1):e15.DOI:10.4081/rt.2012.e15.
[18] Park BK.Renal angiomyolipoma:radiologic classification and imaging features according to the amount of fat[J].AJR Am J Roentgenol,2017,209(4):826-835.DOI:10.2214/AJR.17.17973.
[19] Abduljawad H,Aslan A,Aldoseri K,et al.Rare presentation of inflammatory myofibroblastic tumor in the kidney[J].Radiol Case Rep,2020,15(8):1266-1270.DOI:10.1016/j.radcr.2020.05.043.
[20] Islam M,Saltzman AF,Amini A,et al.Factors influencing overall survival of children,adolescents,and young adults with high-risk renal tumors[J].Urology,2018,120:222-230.DOI:10.1016/j.urology.2018.07.032.
[21] Geller JI,Dome JS.Local lymph node involvement does not predict poor outcome in pediatric renal cell carcinoma[J].Cancer,2004,101(7):1575-1583.DOI:10.1002/cncr.20548.
[22] 宋宏程,黄澄如,孙宁,等.儿童肾细胞癌的临床、病理特点及预后分析[J].中华泌尿外科杂志,2013,34(11):810-813.DOI:10.3760/cma.j.issn.1000-6702.2013.11.003.Song HC,Huang CR,Sun N,et al.Renal cell carcinoma in children:a clinicopathologic study[J].Chin J Urol,2013,34(11):810-813.DOI:10.3760/cma.j.issn.1000-6702.2013.11.003.
[23] Do AY,Kim JS,Choi SJ,et al.Prenatal diagnosis of congenital mesoblastic nephroma[J].Obstet Gynecol Sci,2015,58(5):405-408.DOI:10.5468/ogs.2015.58.5.405.
[24] 孙记航,彭芸,伏利兵,等.儿童肾透明细胞肉瘤的增强CT诊断特征[J].放射学实践,2011,26(4):376-379.DOI:10.3969/j.issn.1000-0313.2011.04.006.Sun JH,Peng Y,Fu LB,et al.Diagnostic features of enhanced computed tomography for renal clear cell sarcoma in children[J].Radiol Pract,2011,26(4):376-379.DOI:10.3969/j.issn.1000-0313.2011.04.006.
[25] Chen Y,Zhou L,Liao N,et al.Specific computed tomography imaging characteristics of congenital mesoblastic nephroma and correlation with ultrasound and pathology[J].J Pediatr Urol,2018,14(6):571.e1-571.e6.DOI:10.1016/j.jpurol.2018.07.020.
[26] Eaton KW,Tooke LS,Wainwright LM,et al.Spectrum of SMARCB1/INI1 mutations in familial and sporadic rhabdoid tumors[J].Pediatr Blood Cancer,2011,56(1):7-15.DOI:10.1002/pbc.22831.
[27] Gooskens SLM,Furtw?ngler R,Vujanic GM,et al.Clear cell sarcoma of the kidney:a review[J].Eur J Cancer,2012,48(14):2219-2226.DOI:10.1016/j.ejca.2012.04.009.
[28] Wong MK,Ng CCY,Kuick CH,et al.Clear cell sarcomas of the kidney are characterised by BCOR gene abnormalities,including exon 15 internal tandem duplications and BCOR-CCNB3 gene fusion[J].Histopathology,2018,72(2):320-329.DOI:10.1111/his.13366.
[29] Ambalavanan M,Geller JI.Treatment of advanced pediatric renal cell carcinoma[J].Pediatr Blood Cancer,2019,66(8):e27766.DOI:10.1002/pbc.27766.
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备注/Memo
收稿日期:2022-5-18。
通讯作者:宋宏程,Email:songhch1975@126.com