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

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.

Publikationsverlauf

Eingereicht: 21. Mai 2024

Angenommen: 25. September 2024

Artikel online veröffentlicht:
18. Oktober 2024

• References

• 1 Williamson KA, Van Heyningen V. Towards an understanding of Wilms' tumour. Int J Exp Pathol 1994; 75 (03) 147-155
• 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
• 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
• 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
• 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
• 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
• 7 Cox S, Büyükünal C, Millar AJW. Surgery for the complex Wilms tumour. Pediatr Surg Int 2020; 36 (02) 113-127
• 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
• 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
• 10 Davidoff AM. Wilms' tumor. Curr Opin Pediatr 2009; 21 (03) 357-364
• 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
• 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
• 13 Beckwith JB, Kiviat NB, Bonadio JF. Nephrogenic rests, nephroblastomatosis, and the pathogenesis of Wilms' tumor. Pediatr Pathol 1990; 10 (1-2): 1-36
• 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
• 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
• 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
• 17 Zuppan C. Role of electron microscopy in the diagnosis of nonneoplastic renal disease in children. Ultrastruct Pathol 2011; 35 (06) 240-244
• 18 Alpers CE, Cotran RS. Neoplasia and glomerular injury. Kidney Int 1986; 30 (04) 465-473
• 19 Burstein DM, Korbet SM, Schwartz MM. Membranous glomerulonephritis and malignancy. Am J Kidney Dis 1993; 22 (01) 5-10
• 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
• 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
• 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
• 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
• 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
• 25 Truong LD, Shen SS, Park MH, Krishnan B. Diagnosing nonneoplastic lesions in nephrectomy specimens. Arch Pathol Lab Med 2009; 133 (02) 189-200
• 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
• 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
• 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