Wilm's tumor

Wilms and Other Pediatric Renal Tumor click to access explanations in the original CAP template

This is additional protocol for biopsy specimen.

OPTIONAL: Expert Consultation before completion of the reporting.

Gross descriptions:

- Procedure:
- Specimen weight (g):
- Specimen laterality:
- Tumor focality (in Specimen or Submitted from One Kidney):
- Tumor size:
- Tumor size:	- Greatest dimensions of additional tumor nodules: Tumor #2 (cm): Tumor #3 (cm): Other (specify):

Microscopic descriptions:

- Tumor histology and immunohistochemical studies:

- Histologic type:
+ Nephrogenic rests:
- Gross or Microscopic Tumor Disruption (pre-op or intra-op):
- Renal Sinus Involved by Viable Tumor:
- Extra-renal Vascular Involvement (renal vein, renal sinus, perinephric soft tissue, other):
- Extension Beyond Renal Capsule by Viable Tumor:
- Direct Extension into Adjacent Organs by Viable Tumor:
+ Lymphovascular invasion:
+ Perineural invasion:
- Post therapy histologic classification (COG):
- Post therapy histologic classification (SIOP):

Complete either the COG or SIOP classification based on treatment protocols.

Surgical margins:

- Vascular margin:
- Ureteral margin:
- Perinephric soft tissue margin:
- Other margin(s) (specify):

* Specify exact distance, greater than, at least, less than or less than 0.1 cm, etc.

Regional (abdominoplevic) lymph nodes:

- Number of regional lymph nodes examined:
- Number of lymph nodes involved (specify locations):
- Extranodal extension:
- Size of largest metastatic deposit (mm), specify site:
- Size of largest lymph node involved (mm), specify site:

Distant Metastasis: Not applicable Not identified Lymph node(s) outside of the abdomino-pelvic region (specify): Lung (specify): Liver (specify): Other (specify): Cannot be determined:

Children’s Oncology Group Staging System (2005):

- Not applicable Nephrogenic rests only

- Local Stage I: Tumor limited to kidney and completely resected No penetration of renal capsule No tumor involvement of extrarenal or renal sinus lymph-vascular spaces identifie No tumor metastasis to lymph nodes

- Local Stage II: Tumor extends beyond kidney but is completely resected Tumor (viable) extends through the renal capsule or involves the perirenal fat or adrenal gland Tumor (viable) involvement of extrarenal or renal sinus lymph-vascular spaces present Tumor (viable) involves renal vein but has not been transected and is not attached to vein wall at resection margin Tumor (viable) infiltrates the wall of the renal pelvis or the ureter Tumor (viable) more than minimally involves the renal sinus soft tissue

- Local Stage III: Residual tumor is suspected Tumor (viable or non-viable) present at margin(s) of resection Tumor (viable or non-viable) rupture identified Tumor spill (viable or non-viable) before or during surgery identified Piecemeal excision of tumor (removal of tumor in more than 1 piece) Metastatic tumor in regional lymph nodes identified History of renal tumor biopsy before definitive surgery Peritoneal tumor implants (viable or non-viable) present anywhere in the abdomen or pelvis

- Stage IV: Metastatic disease Hematogenous metastases or lymph node metastases outside the abdomino-pelvic region

- Stage V: Bilateral renal involvement at diagnosis - Right Kidney Stage:

- Left Kidney Stage:

International Society of Pediatric Oncology Staging for Wilms Tumor Treated with Preoperative Chemotherapy (SIOP):

- Stage I: Tumor is limited to the kidney and is completely resected No penetration of renal capsule No tumor involvement of extrarenal or renal sinus lymph-vascular spaces identifie No tumor metastasis to lymph nodes

- Stage II: Tumor infiltrates locally but is completely excised with negative surgical margins and negative regional lymph nodes Viable tumor infiltrates the renal sinus or blood and / or lymphatic vessels outside the renal parenchyma Viable tumor infiltrates the vena cava or adjacent organs (except for encapsulated adrenal gland invasion, which is stage I if the tumor is encapsulated) Viable tumor within perirenal fat (not surrounded by a pseudocapsule and is completely excised) Viable tumor infiltrates the wall of the renal pelvis or the ureter

- Stage III: Tumor shows residual disease intraabdominally Viable tumor is present at a perinephric resection margin (non-viable tumor or chemotherapy-induced change present at perinephric resection margins is not regarded as stage III) Abdominal lymph nodes contain viable or non-viable tumor Preoperative or intraoperative tumor rupture, if confirmed by microscopic examination (viable tumor at the surface of the specimen in the area of the rupture) Viable or non-viable tumor thrombus is present at resection margins of the ureter, renal vein, or inferior vena cava Viable or non-viable tumor thrombus that is attached to the inferior vena cava wall is removed piecemeal by the surgeon Wedge / open tumor biopsy prior to preoperative chemotherapy or surgery (needle core biopsy does not upstage to SIOP stage III) Tumor implants (viable or non-viable) are found anywhere in the abdomen Tumor (viable or non-viable) has penetrated through the peritoneal surface

- Stage IV: Tumor shows distant metastases Hematogenous metastases (lung, liver, bone, brain, or other) Lymph node metastases outside the abdominopelvic region

- Stage V: Bilateral renal involvement at diagnosis - Right Kidney Stage:

- Left Kidney Stage:

+ Additional pathologic findings: