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Precursor lesions of Wilms' tumor in Indian children: a multiinstitutional study
K Mishra1, M Mathur, K B Logani
1Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.
Insights
Indian children with Wilms' tumor (WT) show distinct precursor lesions (nephrogenic rests) and demographic patterns compared to Western populations. This study highlights significant differences in WT presentation and pathology in India.
Area of Science:
- Pediatric Oncology
- Pathology
- Epidemiology
Background:
- Wilms' tumor (WT) incidence, age, gender, and precursor lesions (nephrogenic rests) vary across ethnic groups.
- Limited data exists on nephrogenic rests in large cohorts outside the U.S.
Purpose of the Study:
- To investigate the incidence and characteristics of nephrogenic rests in Indian children with Wilms' tumor.
- To compare these findings with existing data from Western literature.
Main Methods:
- Histopathology review of 127 Wilms' tumor cases from Indian institutions.
- Correlation of nephrogenic rest incidence with patient age, gender, and tumor morphology.
Main Results:
- Complete absence of perilobar nephrogenic rests observed in all Indian cases.
- Intralobar rests found in 45.3% of WTs, associated with triphasic histology and lower anaplasia rates (1.5%) compared to Western data (4.5%).
- Lower median age (2.5 years) and male gender preponderance noted, differing from Western reports.
Conclusions:
- Nephrogenic rests in Indian children with Wilms' tumor differ from those in Western populations.
- Age and gender incidence, along with morphologic patterns, also show variations.
- Genetic factors may underlie these differences, warranting further epidemiologic and genetic research.
Background:
Studies regarding different ethnic populations of children with Wilms' tumor (WT) in the U. S. have shown differences between age and gender incidence and the type of its precursor lesions (nephrogenic rests). To the authors' knowledge there are few reports in the literature regarding nephrogenic rests in a large number of cases from other parts of the world.
Methods:
In this study, histopathology sections from 127 WTs were pooled from the archives of 4 institutions in northern India and studied for the incidence of nephrogenic rests. Their incidence also was cross-correlated with patient age gender, and tumor morphology.
Results:
Significantly, the complete absence of perilobar nephrogenic rests was observed in all cases. Intralobar rests were associated with 45.3% of WTs and were observed predominantly with a triphasic histologic pattern and a relatively lower incidence of anaplasia compared with reports in the Western literature (1.5% vs. 4.5%). A lower median age of 2.5 years with a peak in the first 2 years of life was consistent with reported studies in Asian children. The male gender preponderance was in contrast to the equal male to female ratio reported in Western cases.
Conclusions:
The type of nephrogenic rests present in Indian children was noted to be different from that in children reported in the Western literature. Differences also existed with regard to the age and gender incidence of children with WT and its morphologic pattern, possibly due to the different genetic nature of the tumor. However, this theory requires confirmation by large epidemiologic and genetic studies.