Interactive Transcript
0:01
Dr. P back with our five-year-old Wilms tumor patient
0:01
3 00:00:03,630 --> 00:00:06,910 and Wilms tumor at gross inspection is typically a
0:06
well-circumscribed or macro-lobulated lesion.
0:11
But I want to illustrate a couple of things here.
0:12
On my sagittal T2 on the far right, I've got a
0:15
little bit of central hyperintense necrosis.
0:19
These lesions also bleed,
0:20
which we've demonstrated previously.
0:23
In the middle, we've got a T2 spin echo with a
0:26
moderate to longish T, about 1500, and a T, about 225.
0:31
So, low signal on the GRE and
0:34
low on the T2 weighted image.
0:36
But the large area of hemorrhage is
0:39
demonstrated as the circumferential area right here.
0:42
And we showed you a large
0:43
subcapsular hemorrhage previously.
0:46
So, this lesion was associated with a lot of blood.
0:49
We showed you calcium before.
0:51
And we're also showing you now, on the
0:53
sagittal T2, an area of central necrosis.
0:57
So let's talk a little bit about what happens
1:01
in Wilm's tumor histologically and biochemically
1:04
that allows this soup of calcium 15%
1:07
of the time, necrosis, hemorrhage, and so on.
1:11
Wilm's tumor histology has a triphasic
1:13
appearance, which consists of stromal, epithelial
1:16
and blastemal elements that basically,
1:19
recapitulates the development of the normal kidney.
1:22
Now, not all tumors are triphasic.
1:24
You get biphasic and monophasic Wilms tumors too.
1:28
And tumors that consist of only one
1:30
blastemal element resemble other small
1:33
round cell tumors like neuroblastoma.
1:36
And that's why location and identifying
1:39
normal adrenal glands is so important.
1:41
Now sometimes you'll even hear the term
1:43
teratoid Wilms tumor, applied if there's differentiation
1:47
along tissue lines not normally found in
1:49
the kidney, such as muscle, osteoid, which
1:53
may simulate the ORTI tumor or cartilage.
1:56
Fat we said may be detected, but you get fat in
1:58
renal cell carcinoma, you get fat in angiomyolipoma.
2:02
Now, 10% of Wilms tumors show
2:04
anaplastic histology, which is,
2:07
is considered an unfavorable prognosis.
2:10
And these tumors often have a very mixed
2:12
pattern of all these things we've described
2:14
with some really exuberant necrosis.
2:16
Let's move on, shall we?
2:17
Dr. P out.
© 2024 Medality. All Rights Reserved.