A 5-year Overview of Forearm Fracture Etiology and Treatment Options in 7-15 Years Old Children

Upenieks, Janis; Sloka, Sintija; Petersons, Aigars; Villerusa, Anita · 2012 · Crossref

DOI: 10.2478/v10163-012-0008-6

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Summary

This study analyzes the morphological spectrum and immunohistochemical characteristics of primary pediatric renal tumors diagnosed in Latvia between 1997 and 2010. The research was motivated by the rarity and diagnostic complexity of childhood renal malignancies, which constitute 7% of all childhood cancers. Accurate histological diagnosis is critical because treatment protocols and prognoses vary significantly among tumor types. The study aimed to characterize these tumors using modern immunohistochemical markers to refine diagnostic accuracy and compare local findings with global epidemiological data. The researchers retrospectively analyzed surgically removed primary renal tumors from the Children’s Clinical University Hospital in Riga. The study excluded secondary tumors and retroperitoneal neoplasms invading the kidney. Of 49 initial cases, 44 were confirmed as primary renal tumors. Tissue samples were fixed in formalin, embedded in paraffin, and stained with haematoxylin-eosin. Immunohistochemical re-investigation was performed on 65.91% of cases using a broad panel of antibodies, including WT1, vimentin, CKAE1/AE3, EMA, Ki67, and INI1 protein, among others. Proliferation activity was assessed via Ki67 labeling. Nephroblastoma (Wilms’ tumor) was the most prevalent diagnosis, accounting for 75% of cases. Other identified tumors included rhabdoid tumor (4.55%), angiomyolipoma (4.55%), mesoblastic nephroma (4.55%), multicystic nephroma (4.55%), clear cell sarcoma (2.27%), embryonal rhabdomyosarcoma (2.27%), and angiosarcoma (2.27%). Notably, no cases of renal cell carcinoma were diagnosed in patients under 18, differing from global statistics. Immunohistochemistry corrected diagnoses in 4.55% of cases: one case initially diagnosed as nephroblastoma was reclassified as neuroblastoma based on neuronal marker expression and WT1 negativity; another case diagnosed as embryonal rhabdomyosarcoma was reclassified as cellular mesoblastic nephroma due to negative muscle markers and vimentin positivity. Rhabdoid tumors were confirmed by the loss of INI1 protein expression. The findings confirm that nephroblastoma is the dominant pediatric renal tumor in Latvia, consistent with worldwide trends. However, rhabdoid tumors appeared more frequently in Latvia than in global reports, while renal cell carcinoma was absent. The study highlights the necessity of extended immunohistochemical schemes for blastemal nephroblastomas and mesenchymal tumors to distinguish them from mimics like neuroblastoma and cellular mesoblastic nephroma. Due to the rarity of rhabdoid tumors and the high cost of INI1 testing, the authors recommend international laboratory cooperation to ensure precise diagnosis and appropriate therapeutic stratification.

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• incidence prevalence