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 acases occur in patients under the age of 10, and most are unilateral. Microscopically, the tumor usually consists of three components:
- A blastemal component (composed of sheets of small blue cells)
- An epithelial component (composed of tumor cells in abortive tubular or glomerular patterns)
- 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:
- Case 1: 20-year-old male who died suddenly
- Case 2: 72-year-old male with right calf mass
- Case 3: 67-year-old female with pancytopenia
- Case 4: 59-year-old male with severe headaches
- Case 5: 38-year-old female with deep venous thrombi
- Case 6: 13-year-old male with cerebellar mass
- Case 7: 45-year-old male with pulmonary emphysema
- Case 8: 38-year-old male with AIDS and headaches
- Case 9: 25-year-old male with arm mass
- Case 10: 57-year-old male with fatigue and left upper quadrant heaviness
- Case 11: 62-year-old male with hepatosplenomegaly, skin lesions and cardiomyopathy
- Case 12: 16-month-old infant with failure to thrive
- Case 13: 36-year-old female with painless lower leg nodule
- Case 14: 58-year-old female with several-year history of pelvic pain
- Case 15: 52-year-old male with abdominal pain and bloody diarrhea
- Case 16Â : 42-year-old female with tinnitus, hearing loss, and a mass at the cerebellopontine angle
- Case 17Â : 52-year-old male with HIV with profuse, watery diarrhea
- Case 18: 44-year-old male with history of progressive weakness and visual changes
- Case 19: 20-year-old male with large, deep thigh mass
- Case 20: 60-year-old male with multiple lung nodules
I have a hard time understanding histopathology …in this microscopic image which ones are the epithelial cells and which ones are blastemal???
You’re not alone! The epithelial cells are the ones that are trying to make little glandular structures. They are particularly noticeable at 10, 11, 1 and 2 o’clock. The blastemal component is the background small, dark blue cells that don’t really look like they’re doing much of anything. These are present throughout the whole slide. Then the stromal component is the region of ligher-staining, more spindle-shaped cells that have a streaming or swirling pattern. They are present largely in the center of the photo, but they are also present in the lower left quadrant of the photo.
Hope that helps!
Kristine
I’m actually an MT seriously considering PathA school, and I had the pleasure of shadowing our path asst this week, and actually saw a Wilm’s tumor the size of a nerf football, so finding this post just made the whole thing so much cooler 😉
Awesome! Glad the post was timely and helpful 🙂
The photo is so typical! Very nice
thanq kristine for great description….
hi Dr.Krafts,
normal M:E ratio is 2:1 to 4:1
but in peripheral circulation its erythroid cells are more in number why is it in BM its low??
am i interpreting wrongly?
You’re correct – the normal myeloid:erythroid ratio (in the bone marrow) is somewhere between 2:1 and 4:1. In the peripheral circulation, however, red cells are way more numerous than white cells. We don’t really talk about an M:E ratio in the peripheral blood – only in the bone marrow.
Useful knowledge everyone should know!