Physical examination of a two year old child reveals a large abdominal mass. CT studies show that the mass arises in the kidney. Which of the following is most likely a distinctive feature of this lesion?
A two-year-old with a tumor of the kidney most likely has Wilms tumor. This aggressive lesion (now with a 90% survival rate ) is microscopically interesting because it contains embryonic glomerular and tubular structures embedded in a spindle cell stroma which may also contain smooth muscle, striated muscle, bone, cailage, fat, and fibrous tissue. Abundant clear cells are a feature of renal cell carcinoma. Eosinophilic cells packed with mitochondria suggests oncocytoma. Hamaomatous blood vessels suggest angiomyolipoma. Ref: Graham D.K., Quinones R.R., Keating A.K., Maloney K., Foreman N.K., Giller R.H., Greffe B.S. (2012). Chapter 31. Neoplastic Disease. In W.W. Hay, Jr., M.J. Levin, R.R. Deterding, J.J. Ross, J.M. Sondheimer (Eds), CURRENT Diagnosis & Treatment: Pediatrics, 21e.
Abundant clear cells
Embryonic glomerular structures
Eosinophilic cells packed with mitochondria
Hamaomatous blood vessels