Study Of Clinicopathological Characteristics And Imaging Features In Children With Wilms Tumor

Part Ⅰ Analysis of the Clinicopathologic Characteristics of Nephroblastoma Objectives: To analyze the clinicopathologic features of nephroblastomas(wilms tumor).Methods: A total of 67 database was established for nephroblastoma cases confirmed by operation and pathology in the Department of Xinhua Hospital.Results: The ratio of the boy to the girl is 1.23:1.More than 86.6% of the patient was under than 5Y.The most common symptom was abdominal mass(37.3%),hematuria(25.4%)and abdominal pain(19.4%).All the 67 patients were taken bad for unilateral kidney.The tumor is generally large,and about 95.5% of them were more than 5cm.Histopathology revealed 63 cases with favorable histology(FH)(94.0%)and 4 cases with unfavorable histology(UFH)(6.0%).Lymph node metastasis and distant metastasis are rare in children with nephroblastom(7.5%,24%),the common metastatic sites were lung,liver and so on.Immunohistochemistry,WT1 positive expression was 23.9%,P53 and NSE expression was mostly negative(70.2%,58.2%),Ki-67 expression between 30%-80%.Histological types(FH and UFH)in children with nephroblastom had no significant correlation with age,gender,lymph node metastasis and distant metastasis(p>0.05).There was no significant correlation in gender,age,tumor diameter,tumor location and clinical manifestations,histological type,lymph node metastasis,recurrence and metastasis,P53 expression and Ki-67 expression neither(p> 0.05).Conclusion : Wilms tumor has certain clinicopathological features,which can help to guide clinical treatment and predict prognosis.Part Ⅱ Imaging diagnosis and differential diagnosis of pediatric nephroblastomaObjective: To investigate the role of CT and MR in the diagnosis and differential diagnosis of nephroblastoma(Wilms tumor),and to improve the accuracy of diagnosis of wilms tumor and to highlight its accuracy and advantage in other imaging modalities.Methods: A retrospective analysis of 67 cases of nephroblastoma confirmed by clinical,surgical and pathological features in Xinhua Hospital from 2013 to 2016 was performed.All patients underwent preoperative CT scan,patially coincident with MRI.Results: In 67 children with Wilms tumor,the ratio of male to female was 1.23: 1,the age of onset was less than 5 years(86.6%),and the clinical manifestations were mostly abdominal mass(37.3%),hematuria(25.4%)and Abdominal pain(19.4%).Children are all unilateral disease,tumor diameter more than 5cm is about95.5%.In 58 cases of solid-based lesions,cystic-based cases in 9 cases,of which 4cases were diagnosed as partially differentiated nephroblastoma.Enhanced CT scan was uneven enhancement,often accompanied by necrosis,bleeding,calcification can occur within the mass.Nephrotic generally showed the ball holding sign performance,mass generally larger,and with the envelope,can grow across the midline,but not around the large blood vessels.Tumors can invade extrarenal macrovascular invasion and thrombus(11.9%).Nephroblastoma in children with lymph node metastasis and distant metastasis are rare(7.5%,24%).The common metastatic sites of lung,liver and so on.No significant bone destruction in all cases.Conclusion: The imaging of nephroblastoma can not only show the morphology of the tumor,but also determine the pathological changes of the abdominal vessels and lymph nodes.Therefore,it is of great value in the staging of tumors,the treatment and differential diagnosis of tumors.Part Ⅲ The Value of CT Radiographic Features of Wilms’ Based on Surgical Risk AssessmentObjectives:To investigate the correlation between preoperative imaging features and surgical risks of wilms tumor.Methods: Retrospective analysis of Xinhua Hospital,2013-2016,pathologically confirmed 32 cases of children with Wilms tumor in patients with clinicopathological and surgical data.Postoperative patients were followed up for more than 6 months and the data were completed.Collect various preoperative imaging parameters such as tumor size,tumor volume,large vessel displacement,tumor extension to the contralateral side,and analyze the relationship between imaging parameters and operation time,bleeding and tumor rupture.Results: Tumor in 22 patients with tumor or inferior vena cava tumor thrombus,as high-risk surgery group,10 patients with smaller tumor size,as low-risk surgery group.After analysis,the operation time and the amount of bleeding and tumor size,size,volume,whether the compression of large blood vessels and whether the tumor is extending to the contralateral side there is a correlation.Conclusion: wilms tumor patients with preoperative reference CT images,definite imaging features,are easy to determine the shape of the tumor and the violations of the surrounding organs.Patients with higher surgical risk of chemotherapy in early intervention to control risk factors,can be reduced surgical risk,and reduce the overuse of chemotherapy drugs.