Paediatric Tumours

Wilms' tumours: comprise more than 80% of renal tumours of childhood, usually in children 2 to 4 years old. There is a slight preponderance of females. Associations with congenital anomalies - cryptorchidism, hypospadias, other genital anomalies, hemihypertrophy, and aniridia -are well recognised. Wilms' tumours are usually large masses; more than 5 cm and solid. They are composed of variable admixtures of blastema, epithelium and stroma. The epithelial component usually consists of small tubules or cysts lined by primitive columnar or cuboidal cells. The stroma may differentiate along the lines of almost any type of soft tissue.

They are divided into two categories: favourable and unfavourable histology, based on the absence or presence of cellular anaplasia, which is found in approximately 6% of Wilms' tumours and can be associated with an adverse outcome. Thus, it is important to sample Wilms' tumour specimens extensively. The usual treatment approach in most patients is nephrectomy followed by chemotherapy (vincristine, dactinomycin, doxorubicin) with or without postoperative radiotherapy (> pT2). With current strategies, survival rates are approaching 90%.

Other paediatric renal tumours: cystic nephroma, mesoblastic nephroma, clear cell sarcoma of the kidney, rhabdoid tumour, metanephric adenofibroma, ossifying renal tumour of infancy, lym-phangioma, intrarenal teratoma and uncommon tumours - renal cell carcinoma, lymphoreticular and haematopoietic tumours.

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