Congenital mesoblastic nephroma: a single-center retrospective study

Congenital mesoblastic nephroma (CMN) is a rare renal tumor predominantly occurring in neonates and young infants, and standardized treatment guidelines remain lacking. This study aimed to summarize the clinical features, therapeutic strategies, and outcomes of CMN patients from a single institution to inform clinical practice.

We retrospectively reviewed the medical records of nine children with pathologically and molecularly confirmed CMN treated at Children's Hospital of Nanjing Medical University between 2015 and 2024. Demographic characteristics, clinical presentation, imaging findings, histological subtypes, gene fusions, treatment approaches, and follow-up data were analyzed.

The median age at diagnosis was 2.5 months (range: newborn to 93 months), with a male-to-female ratio of 2:1. Most patients (90%) presented with an abdominal mass detected prenatally or incidentally. The tumor originated from the right kidney in seven cases and the left in two. Ultrasound and computed tomography (CT) commonly revealed mixed cystic-solid masses, with heterogeneous enhancement on contrast imaging. Pathological subtypes included cellular (n=5), classic (n=2), and mixed (n=2). Of seven patients undergoing fluorescence in situ hybridization (FISH), three were positive for the ETV6::NTRK3 fusion; four were negative; and two relapsed patients underwent next-generation sequencing (NGS), which identified TPM3::NTRK1 and EGFR-kinase domain duplication (EGFR-KDD), respectively. All patients underwent surgical resection with a 100% resection rate. Two relapsed patients received salvage chemotherapy [vincristine-actinomycin D-cyclophosphamide (VAC) or ifosfamide-carboplatin-etoposide (ICE)], which showed limited efficacy. One relapsed patient with TPM3::NTRK1 received larotrectinib but died two months later; another with EGFR-KDD experienced disease stabilization after afatinib plus programmed cell death protein 1 (PD-1) blockade following progression on entrectinib and anlotinib. After a median follow-up of 36 months (range: 12-115 months), the overall survival was 88.9%, and the event-free survival was 77.8%.

This small single-center case series describes the clinical and molecular heterogeneity of CMN. While most patients experienced favorable outcomes following surgery, relapsed cases highlight the challenges associated with molecularly atypical disease. These observations are descriptive in nature and underscore the need for larger collaborative studies to better define prognostic factors and optimal management strategies in CMN.