Genetics of nephroblastoma. II. The incidence of developmental defects and dysplastic and asymmetrical traits in children with nephroblastoma

The frequency of developmental defects and displasticity characters in children with nephroblastoma was determined in two groups--with early, up to 2 years manifestation of the tumor (ENB), in 40 patients, and with advanced nephroblastoma (ANB), in 59 patients (manifestation of the disease after 2 years). The data were correlated with control groups adequate for age (130 children). The frequency of serious developmental defects was higher in ANB group (20%) than in ENB group (7%). Over a half of developmental defects were hemihypertrophy and doubling of organs. One case of a child with the combination of nephroblastoma and Smith-Lemli-Opitz syndrome was defined. In ANB group an increased frequency of asymmetry in the conjugate organs (foot, hand, middle finger, ears) was found. Its direction is correlated with tumor localization (tumor site). In ENB group no analogous effect was shown. The data obtained present phenotype characteristics of groups with early and late manifestation of the disease which are probably different in their genesis and thus, their identification is necessary for the adequate medicogenetic consultation (examination).     

Genetics of nephroblastoma. I. The heterogeneity of nephroblastoma

The age of disease onset, sex, birth weight and stature were analysed in 150 children suffering from nephroblastoma. The material was compared with its own control group (92 normal children of the same age) and with the population data from literature. All nephroblastoma patients were divided into 2 groups by the age of disease onset: before 2 years old and after this. The proband birth weight and stature in the first group statistically differed from control and population exponents. Genetic heterogeneity of nephroblastoma is discussed.     

Nephroblastomatosis and nephroblastoma in nonhuman primates

Wilms' tumors, or nephroblastomas, are renal embryonal malignancies with a high incidence in humans. Nephroblastomas are uncommon in nonhuman primates. This report describes three cases of spontaneous proliferative renal tumors in young monkeys: two cases of unilateral kidney nephroblastomas in baboons and a nephroblastomatosis in a cynomolgus macaque. Histologically, both baboon tumors were typical of Wilms' tumors found in humans, with proliferative epithelial cells forming tubules and aborted glomeruli, nephrogenic rests and proliferative fibrovascular tissue. The left kidney of the macaque was markedly enlarged and histologically similar to the baboon tumors, although normal kidney architecture was completely effaced by primitive tubules and occasional glomeruli surrounded by edematous stromal tissue. Cytogenetic analysis did not detect any macaque or baboon equivalents to human Wilms' tumor chromosomal abnormalities. By human pathology classification, the diffuse nature of the macaque tumor is more consistent with nephroblastomatosis than nephroblastoma. This differentiation is the first to be reported in a species other than human. The nephroblastomas described here are the first nephroblastomas to be reported in baboons. Our observations indicate that nonhuman primate nephroblastomatosis and nephroblastomas develop in a similar way to Wilms' tumors in humans, although no genetic marker has been associated with nephroblastomas of nonhuman primates thus far.     

A case report of infantile cystic nephroblastoma

Background

Nephroblastoma (NB) is a malignant embryonal neoplasm derived from nephrogenic blastemal cells. NB usually forms a solid mass, but in extremely rare cases, it may show cystic changes.

Case presentation

A six-month-old girl with persistent high fevers was found to have pyuria and bacteriuria. Ultrasonography revealed multilocular cysts in the right kidney. Right nephrectomy was performed with cyst wall rupture during surgery. An intraoperative rapid diagnosis, based on peritoneal fluid cytology, confirmed three components of blastemal, stromal, and epithelial cells. The blastemal cells were dyshesive, with scant to no cytoplasm and were the predominant cell type. The spindle-shaped stromal cells were arranged in fascicles. The epithelial cells demonstrated tubular structures. Macroscopically, the resected cystic tumor measured 80 mm in maximum diameter with a prominently thin cyst wall, but solid areas were also apparent. Histologically, the tumor was diagnosed as cystic NB (blastemal-predominant) displaying a triphasic pattern. Hyperchromatic nuclei and apoptotic bodies were found. The clinical stage classification of Japan Wilms Tumor Study group was 3. The patient was treated with chemotherapy and radiotherapy. Tumor recurrence and metastasis have not been observed in the 8 months since surgery.

Conclusion

This is an extremely rare case of infantile cystic NB. We diagnosed the NB cells that appeared in the peritoneal fluid by intraoperative rapid cytology. Cytological examination proved to be a very useful technique for determining the clinical stage of NB. Additionally, we propose that massive tumor degeneration and necrosis be considered as a pathogenic mechanism of cyst formation in NB.

     

Infrequent involvement of c-fos in avian leukosis virus-induced nephroblastoma.

To determine whether c-fos is involved in avian leukosis virus-induced nephroblastoma, 28 tumors from chickens were analyzed for novel fos fragments. DNA from 1 of 16 clonal outgrowths (in chicken 6561) contained novel fos-related EcoRI and KpnI fragments which hybridized to both v-fos and viral probes. Oncogenicity tests using filtered 6561 tumor cell homogenates did not reveal a tumor-inducing transduction of c-fos. We conclude that c-fos is only an occasional target for proviral insertions or new transductions in avian leukosis virus-induced nephroblastoma. The results also identify a polymorphism in c-fos in K28 chickens and demonstrate that unintegrated viral DNA is not a general characteristic of avian leukosis virus-induced nephroblastoma.     

Osteoprotegerin in Bone Metastases: Mathematical Solution to the Puzzle

Bone is a common site for cancer metastasis. To create space for their growth, cancer cells stimulate bone resorbing osteoclasts. Cytokine RANKL is a key osteoclast activator, while osteoprotegerin (OPG) is a RANKL decoy receptor and an inhibitor of osteoclastogenesis. Consistently, systemic application of OPG decreases metastatic tumor burden in bone. However, OPG produced locally by cancer cells was shown to enhance osteolysis and tumor growth. We propose that OPG produced by cancer cells causes a local reduction in RANKL levels, inducing a steeper RANKL gradient away from the tumor and towards the bone tissue, resulting in faster resorption and tumor expansion. We tested this hypothesis using a mathematical model of nonlinear partial differential equations describing the spatial dynamics of OPG, RANKL, PTHrP, osteoclasts, tumor and bone mass. We demonstrate that at lower expression rates, tumor-derived OPG enhances the chemotactic RANKL gradient and osteolysis, whereas at higher expression rates OPG broadly inhibits RANKL and decreases osteolysis and tumor burden. Moreover, tumor expression of a soluble mediator inducing RANKL in the host tissue, such as PTHrP, is important for correct orientation of the RANKL gradient. A meta-analysis of OPG, RANKL and PTHrP expression in normal prostate, carcinoma and metastatic tissues demonstrated an increase in expression of OPG, but not RANKL, in metastatic prostate cancer, and positive correlation between OPG and PTHrP in metastatic prostate cancer. The proposed mechanism highlights the importance of the spatial distribution of receptors, decoys and ligands, and can be applied to other systems involving regulation of spatially anisotropic processes.     

Lectin histochemistry of nephroblastoma (Wilms' tumour)

Summary Paraffin sections of seven cases of nephroblastoma and one case of clear cell sarcoma were stained with a battery of eleven lectins conjugated to horseradish peroxidase. Lectin staining revealed similarities between blastema and stroma with respect to their content of glycoconjugates whereas blastema and epithelial cells exhibited major differences. In general, blastema and stroma contained glycoconjugates with terminal or penultimate -galactose, glycoconjugates having either biantennary or triantennary N-linked sugar chains or both, sialoglycoconjugates, and occasionally glycogen. Epithelial cells also showed these complex carbohydrates but stained additionally for terminal disaccharide galactose-(13)-N-acetylgalactosamine, terminal -galactose and terminal -N-acetylgalactosamine. Furthermore, staining with three fucose-binding lectins revealed that the linkage between terminal -fucose residues to the constituent oligosaccharide chains varied between epithelial cells, blastema and stroma. In general, the distribution and content of glycoconjugates in tumour cells comprising clear cell sarcoma resembled that in blastema and stroma of nephroblastoma. Other findings included differences in content of glycosubstance between cuboidal and columnar cells within the same tumour. Also observed were variations between a primary tumour and its metastasis with respect to the occurrence of certain complex carbohydrates.     

Feasibility and limitations of bone marrow transplantation in children

Bone marrow transplantation (BMT) has been used increasingly for the treatment of patients with a variety of hematological, immunological and oncological diseases. Originally a highly experimental and often unsuccessful procedure, it has become the treatment modality of choice for selected leukemias, severe aplastic anemia, genetic diseases and solid tumors. Despite the overall success of bone marrow transplantation, a number of serious and potentially fatal complications may occur. Conditioning regimens include chemotherapeutic and radiotherapeutic techniques immunosuppressive enough to allow engraftment of genetically foreign marrow. Graft-versus-host disease (GvHD) is one of the major clinical problems complicating allogeneic BMT. Two forms have been described, acute and chronic GvHD. BMT recipients frequently develop infections complications.     

Metastases to skeletal muscles and interferon treatment.

Blood-borne metastases to a skeletal muscle are rare and may originate in various primary tumors. Recurrent solitary metastasis of renal cell carcinoma, and metastatic lesion as part of disseminated malignant melanoma in skeletal muscles are reported in two patients. In both cases interferon treatment with or without chemotherapy failed in arresting the disease.     

Computational simulation of spontaneous bone straightening in growing children

Periosteal surface pressures have been shown to inhibit bone formation and induce bone resorption, while tensile strains perpendicular to the periosteal surface have been shown to inhibit bone resorption and induce new bone deposition. A new computational model was developed to incorporate these experimental findings into simulations of spontaneous bone straightening in children with congenital posteromedial bowing of the tibia. Three-dimensional finite element models of the periosteum were used to determine the relationships between the defect angle and the distribution of bone surface pressures and strains due to growth-generated tensile strains in the periosteum. These relationships were incorporated into an iterative simulation to model development of a growing, bowed tibia with an initial defect angle of 27°. When periosteal loads were included in the simulation, the defect angle decreased to 10° after 2 years, and the bone straightened by an age of 25 years. When periosteal loads were not included in the simulation, the defect angle decreased to 23° after 2 years, and a defect angle of 9° remained at an age of 25 years. A “modeling drift” bone apposition/resorption pattern appeared only when periosteal loads were included. The results suggest that periosteal pressures and tensile strains induced by bone bowing can accelerate the process of bone straightening and lead to more complete correction of congenital bowing defects. Including the mechanobiological effects of periosteal surface loads in the simulations produced results similar to those seen clinically, with rapid straightening during the first few years of growth.     

Adrenal steroid hormones and metaphyseal bone in children

BACKGROUND/OBJECTIVES: The responses of metaphyseal bone tissue to physiological variations of endogenous adrenal steroid hormones during childhood are unclear. Therefore, we studied potential hormonal influences in children before the appearance of pubic hair (onset of pubarche). METHODS: Excretions of major glucocorticoid metabolites (C21), cortisol, sum of adrenarchal dehydroepiandrosterone and its immediate 16-hydroxylated metabolites (DHEA&M), and 5-androstene-3beta,17beta-diol (hermaphrodiol) were analyzed in a cross-sectional study in 24-hour urine samples of 109 healthy boys and girls, aged 6-13 years, using steroid profiling by gas chromatography-mass spectrometry. Total and trabecular volumetric bone mineral densities, bone mineral content (BMC) and bone strength strain index were determined with peripheral quantitative computed tomography at the distal forearm. RESULTS: In multiple regression analyses significant associations with the metaphyseal radius were seen for grip force, age, or BMI depending on gender and bone variable analyzed. DHEA&M did not contribute to the explanation of the variance of any bone variable. However, hermaphrodiol positively explained a significant part of variation of bone mineral densities, and BMC (p < 0.01) in girls. Significantly negative associations with all bone variables were seen in boys for cortisol. CONCLUSIONS: The steroid hormones, cortisol and hermaphrodiol, in their physiological ranges, but not the adrenarche marker DHEA&M, appear to associate with metaphyseal bone in a sex-dependent manner during childhood.     

Benign orbital tumors with bone destruction in children

Purpose

To present rare benign orbital tumors with bone destruction in children who could not be diagnosed pre-surgically and may simulate malignant ones.

Methods

A retrospective review of cases. Clinical, operative and pathological records in all children with a diagnosis of benign orbital tumors who showed remarkable bone destruction at a tertiary Ophthalmic Center in China between Jan 1, 2000 and Dec 31, 2009 were reviewed. All patients had definitive histopathologic diagnosis.

Results

Eight patients with benign orbital tumors showed obvious bone destruction, including six cases of eosinophilic granuloma, one case of leiomyoma and one case of primary orbital intraosseous hemangioma. Among them, three patients were females and five patients were males. Tumors were unilateral in all cases, with both the right and left side affected equally. Age ranged from 3 to 7 years (mean 4.1 years). Symptom duration ranged from 1 to 5 weeks (mean 4.8 weeks). Eyelid swelling and palpable mass were the most common complaint. There was no evidence for multifocal involvement in cases with eosinophilic granuloma. Among six patients with eosinophilic granuloma, two were treated with low dose radiation (10 Gy), three received systemic corticosteroid and one was periodically observed only after incisional biopsy or subtotal curettage. There was no postoperative therapeutic intervention in the two patients with leiomyoma and intraosseous hemangioma. All eight patients regained normal vision without local recurrence after a mean follow-up time of 32.8 months.

Conclusion

Benign orbital tumors such as isolated eosinophilic granuloma, leiomyoma and primary orbital intraosseous hemangioma may show remarkable bone destruction.