This document discusses neuroblastoma and nephroblastoma (Wilms tumor). Neuroblastoma is the most common extracranial solid tumor in children, arising from the sympathetic nervous system. It presents heterogeneously from spontaneous regression to aggressive forms. The causes are largely unknown. Nephroblastoma (Wilms tumor) is the most common malignant renal tumor of childhood. Both tumors are diagnosed through imaging and urine/blood tests. Prognosis and treatment varies depending on tumor histology and staging. Aggressive forms of neuroblastoma and anaplastic Wilms tumor remain difficult to treat.
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
Approach to a Child with an Abdominal Mass and tumours.pptxJwan AlSofi
Clinically oriented approach to a child with abdominal mass.
Discussion about Neuroblastoma
Discussion about Wilms tumor
Discussion about Hepatic tumors
Case discussions
Medulloblastoma- A primitive neuroectodermal tumors (PNETs) is the most common malignant brain tumor of childhood (WHO IV)
arising from the vermis in the inferior medullary velum.
It comprises up to 18% of all pediatric brain tumors.
WNT and Shh pathway plays major role in its pathogenesis.
c-erbB-2 (HER2/neu) oncogene expression has prognostic value. Norcantharidin, Vismodegib, Sonidegib are the future in medulloblastoma.
Approach to a Child with an Abdominal Mass and tumours.pptxJwan AlSofi
Clinically oriented approach to a child with abdominal mass.
Discussion about Neuroblastoma
Discussion about Wilms tumor
Discussion about Hepatic tumors
Case discussions
multiple myloma
By: Nader Amir Al-assadi
Supervised by : Dr/ Ghazi Alariqe
taiz university
Multiple myeloma (MM) is a plasma cell malignancy in which monoclonal plasma cells proliferate in bone marrow, resulting in an over abundance of monoclonal para protein (M protein), destruction of bone, and displacement of other hematopoietic cell lines.
The precise etiology of MM has not yet been established.
Roles have been suggested for a variety of factors, including genetic causes, environmental or occupational causes,radiation, chronic inflammation, and infection .
Neuroblastoma diagnosis, treatment, complications, and further management. The main contents of this review have been accessed from MedScape. Please do not reprint or copy this material without permission from the copyright owner.
Neuroblastoma is the most common cancer in babies and the third-most common cancer in children after leukemia and brain cancer, proper diagnosis, treatment must be done in appropriate time. As it a fatal condition psychosocial support is most important for patient and family.
Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non–vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non–vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation.
Dr. mahajna muhammad MD
sackler faculty of medicine
Tel-Aviv Uni.
The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y12 receptor antagonist with established efficacy after an acute coronary syndrome, in this context.
updated 2017 -
clinical approach and overview
clinical manifestation
diagnosis
treatment
complications.
Dr.mahajna muhammad
plastic surgery department
Tel_Aviv-Uni
Initial evaluation and management of small and moderate burns is a routine part of general plastic surgery practice. An ability to accurately evaluate and provide proper initial care for these injuries is essential.
Outcomes for patients with burns have improved dramatically over the past 20 years, but burns still cause substantial morbidity and mortality. [1] Proper evaluation and management, coupled with appropriate early specialty referral, greatly help in minimizing suffering and optimizing results
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. definition
embryonal cancers of the peripheral sympathetic nervous
system
heterogeneous clinical presentation and course, ranging
from tumors that undergo spontaneous regression to very
aggressive tumors
The causes of most cases remain unknown, and although
significant advances have been made in the treatment of
children with these Tumors
the outcomes for aggressive forms of neuroblastoma
remain poor.
3. the most common extracranial solid tumor in children and
the most commonly diagnosed malignancy in infants.
8-10% of childhood malignancies and 33% of cancers in
infants.
accounts for >15% of the mortality from cancer in children.
The median age of children at diagnosis of neuroblastoma
is 22 months
90% diagnosed by 5 yr of age.
The incidence is slightly higher in boys and in whites.
EPIDEMIOLOGY
4. variable degrees of neural differentiation, ranging from tumors with
1. primarily undifferentiated small round cells (neuroblastoma)
2. tumors consisting of mature and maturing Schwannian stroma with
ganglion cells (ganglio-neuroblastoma or ganglio-neuroma).
The tumors may resemble other small round blue cell tumors, such as
rhabdomyosarcoma, Ewing sarcoma, and non Hodgkin lymphoma.
The prognosis varies with the histologic features of the tumor, and
prognostic factors
1. Schwannian stroma,
2. the degree of tumor cell differentiation,
3. mitosis-karyorrhexis index.
PATHOLOGY
5. • The etiology of neuroblastoma in most cases remains unknown
• Familial neuroblastoma accounts for 1-2% of all cases, is associated with a
younger age ,mutations in PHOX2B and ALK genes.
• The BARD1 gene has also been identified as a major genetic contributor to
neuroblastoma risk.
• associated with other neural crest disorders, [Hirschsprung disease, central
hypoventilation syndrome, and neurofibromatosis type I] and potentially
congenital cardiovascular malformations (Table 498-1).
• associated with parents occupation,chemical although no single environmental
exposure has been shown to directly cause neuroblastoma.
PATHOGENESIS
6. Genetics include
1. amplification of the MYCN (N-myc) : strongly associated with advanced tumor
stage and poor outcomes
2. ploidy :Hyperdiploidy confers better prognosis if the child is younger than 1 yr
of age at diagnosis
3. Other: including loss of heterozygosity of 1p, 11q, and 14q, and gain of 17q,
associated with worse outcomes.
In addition, tumor vascularity and the expression levels of nerve growth factor
receptors : (TrkA, TrkB),
chromogranin Aneuropeptide YLDHferritin
ganglioside GD2CD44telomerase
10. Metastatic disease can cause a variety of signs and symptoms:
1. Fever
2. Irritability
3. failure to thrive
4. bone pain
5. Cytopenias
6. bluish subcutaneous nodules
7. orbital proptosis
8. periorbital ecchymoses
Localized disease can manifest as an asymptomatic mass or can cause symptoms
because of the mass itself:
1. spinal cord compression,
2. bowel obstruction, and superior vena cava syndrome.
superior cervical ganglion can result in Horner syndrome.
Paraspinal neuroblastoma tumors can invade the neural foramina, causing spinal
cord and nerve root compression.
paraneoplastic syndrome of autoimmune origin, termed opsoclonus–
myoclonus–ataxia syndrome, in which patients experience rapid,
uncontrollable jerking eye and body movements, poor coordination,
11. Some tumors produce catecholamines that can cause
1. increased sweating and hypertension
some release vasoactive intestinal peptide
1. causing a profound secretory diarrhea.
Children with extensive tumors can also experience tumor lysis
syndrome
and disseminated intravascular coagulation.
Infants younger than 1 yr of age also can present in unique fashion,
termed stage 4S :
• widespread subcutaneous tumor nodules
• massive liver involvement
• limited bone marrow disease
• small primary tumor without bone involvement or other metastases.
12. Staging
Neuroblastoma may develop at any site of sympathetic nervous system tissue.
50% of neuroblastoma tumors arise in the adrenal glands
Metastatic spread :
1. mainly in 1 yr of age at diagnosis,
2. occurs via local invasion
3. distant hematogenous
4. lymphatic routes.
5. The most common sites of metastasis are the regional or distant lymph nodes,
long
a) bones and skull, bone marrow
b) liver, and skin
c) Lung and brain metastases are rare, occurring in >3% of cases.
13.
14. DIAGNOSIS
RADIOLOGY : MRI / CT mass or multiple masses may be hemorrhagic or
calcified
Urin samples :
Tumor markers, catecholamine metabolites homovanillic acid and vanillylmandelic
acid, are elevated in the urine in 95% of
Evaluations for metastatic disease should include CT or MRI of the
chest and abdomen, bone scans to detect cortical bone involvement,
and at least 2 independent bone marrow aspirations
15. • A :CT scan of an abdominal neuroblastoma with central necrosis at diagnosis.
• B :Coronal fused CT and metaiodobenzylguanidine(MIBG) image of same child with
extensive retroperitoneal mass and central necrosis, probably an adrenal primary
with extensive lymph node involvement.
• C :MIBG avid neuroblastoma with increased uptake of radiolabeled tracer can be
detected in multiple sites of disease, including bone and soft tissue.
16.
17.
18.
19. These agents are almost invariably given in combination
Commonly used combinations include the following:
•Vincristine, cyclophosphamide, and doxorubicin
•Carboplatin and etoposide
•Cisplatin and etoposide
•Cyclophosphamide and topotecan
Consolidation regimens used in neuroblastoma include the following:
•Carboplatin and etoposide with melphalan or cyclophosphamide
•Thiotepa and cyclophosphamide
•Melphalan and total body irradiation
20. Induction chemotherapy for children with high-risk neuroblastoma includes
combinations
1. Cyclophosphamide
2. topotecan,
3. Doxorubicin
4. Vincristine
5. Cisplatin
6. etoposide.
After completion autologous stem cell rescue and focal radiation therapy to tumor
sites.
significantly better survival with chemotherapy plus autologous stem cell rescue
than with chemotherapy alone.
The further addition of 13-cis-retinoic acid resulted in further improvements in
survival rates.
21. Now hush little baby, don't you cry
Everything's gonna be alright
Stiffen that upper lip up little lady, I
told ya Daddy's here to hold, ya
through the night
22.
23. • Wilms tumor (WT), also known as nephroblastoma, is the most common
primary malignant renal tumor of childhood;
• other renal tumors are very rare.
• It is the second most common malignant abdominal tumor in childhood.
• The most common sites of metastases
1. lungs,
2. regional lymph nodes
3. and liver.
Histologically:varying proportions
1. Blastemal
2. Stromal
3. epithelial cells
24. EPIDEMIOLOGY
6% of malignancies and more than 95% of kidney tumors.
75% occur in children younger than 5 yr with a peak incidence at 2-3 yr of age.
It can arise in 1 or both kidneys; bilateral WTs is 7%.
Most cases are sporadic, but approximately 2% of patients have a family history.
In 8-10% of patients, WT is observed in the context of hemihypertrophy, aniridia,
genitourinary anomalies, and a variety of rare syndromes:
Beckwith-Wiedemann syndrome and Denys-Drash syndrome (Table 499-2).
An earlier age of diagnosis and an increased incidence of bilateral
disease are generally observed in syndromic and familial cases.
25.
26. ETIOLOGY: GENETICS AND
MOLECULAR BIOLOGY
Wilms tumor is thought to be caused by alterations of genes
responsible for normal genitourinary development. Examples
of common congenital anomalies associated with Wilms tumor
are
1. Cryptorchidism
2. a double collecting system
3. horseshoe kidney
4. and hypospadias. |
Environmental exposures, although considered, seem relatively
unlikely to play a role
27. a gene located at 11p13 and encoding a zinc finger transcription factor
15-20% of tumors. These are homozygous and result in loss of WT1 Function.
The majority of WT1 mutations are somatic, result in loss of WT1 function, and
are present homozygously.
germline WT1 mutations are also observed, primarily in patients with WT-
associated syndromes, or sometimes in patients with bilateral disease.
In these instances, the wild-type allele present in the germline is mutated or
lost in the tumor, resulting in loss of WT1 function. Interestingly, nephrogenic
rests assessed from patients heterozygous
30. 80% asymptomatic abdominal mass:
abdominal mass occurs in 80% of children at presentation.
Abdominal pain or hematuria occurs in 25%.
Urinary tract infection
varicocele are less common findings than these.
Hypertension, gross hematuria, and fever are observed in 5-30
A few patients with hemorrhage into their tumor may present with
hypotension, anemia, and fever.
Rare patients with advanced disease may present with respiratory
symptoms related to lung metastases.
31.
32. Imaging studies
1. plain abdominal radiography,
2. abdominal ultrasonography,
3. CT of the
4. Abdominal ultrasonography helps differentiate solid from cystic
Masses
5. Ultrasonography with Doppler imaging of renal veins and the
inferior
vena cava is a useful first study that not only can look for WT but also
can evaluate the collecting system and demonstrate tumor thrombi in
the renal veins and inferior vena cava.
33.
34.
35.
36. •Favorable - Contains well developed components mentioned above
•Anaplastic - Contains diffuse anaplasia (poorly developed cells)