Pathology, JIPMER, Puducherry, India.
Radiodiagnosis, JIPMER, Puducherry, India.
Diagn Cytopathol. 2021 Jun;49(6):E190-E194. doi: 10.1002/dc.24666. Epub 2020 Nov 18.
A 12-year-old male child presented with complaints of a slow growing swelling in the right parasternal region noticed since one month. On examination, the lump was 2 × 2 cm firm, mobile nontender located in the subcutaneous plane which was also confirmed radiologically. Fine needle aspiration cytology was attempted showed small to medium sized monotonous round cell morphology, nuclear molding and mitotic figures were frequent. Few cells exhibiting rosettoid arrangement. No definite epithelial or mesenchymal component was evident. No glio-fibrillary matrix or lymphoglandular bodies were evident in the smears. Based on morphology, a small round cell tumor was considered with possibilities of Wilm's tumor and Ewing's family of tumor. Based on morphological differentials ICC was requested, tumor cells were positive for strong nuclear WT1 staining while CK and FLI1 were negative. The cytomorphology along with the ICC confirmed the diagnosis of metastatic wilm's tumor. Seven years back, patient had a history of nephrectomy, which on histopathology was reported as triphasic Wilms tumor with favorable histology. Generally Wilm's tumor recurs within 2 years of diagnosis. Late recurrence in Wilm's tumor is rare with only a handful of case reports. Common sites for metastasis include lung, liver, contralateral kidney. Cutaneous metastasis is very uncommon, early detection of which with helps in therapeutic and prognostic decisions. The interesting aspect of this article is cytological detection of cutaneous metastasis of late recurrence Wilm's tumor, which is extremely rare to occur.
一位 12 岁男性患儿因右胸骨旁区逐渐增大的肿块就诊，该肿块自一个月前出现。体格检查发现肿块为 2×2cm 大小，质硬，可移动，无触痛，位于皮下平面，影像学检查也证实了这一点。细针抽吸细胞学检查显示中等大小的单一圆形细胞形态，核有丝分裂象和核多形性常见。少数细胞呈玫瑰花结样排列。未见明确的上皮或间叶成分。涂片上未见神经胶质纤维或淋巴腺小体。根据形态学，考虑为小圆细胞肿瘤，可能是 Wilm 瘤和 Ewing 家族肿瘤。根据形态学差异，请求进行免疫细胞化学检查，肿瘤细胞 WT1 核染色强阳性，而 CK 和 FLI1 均阴性。细胞学形态学和免疫细胞化学检查共同证实了转移性 Wilm 瘤的诊断。七年前，患者曾行肾切除术，组织病理学报告为三型 Wilms 瘤，组织学良好。一般来说，Wilms 瘤在诊断后 2 年内复发。Wilms 瘤的晚期复发罕见，仅有少数病例报告。常见的转移部位包括肺、肝、对侧肾脏。皮肤转移非常罕见，早期发现有助于治疗和预后决策。本文的有趣之处在于 Wilm 瘤晚期复发的皮肤转移的细胞学检测，这极其罕见。
