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REVIEW OF PEDIATRIC RENAL NEOPLASMS
John Hicks
Texas Children's Hospital, Houston, TX

MALIGNANT RHABDOID TUMOR OF KIDNEY

INDEX

Malignant Rhabdoid Tumor of Kidney: Epidemiology

Originally Considered "Rhabdomyosarcomatoid" Variant
of Wilms Tumor (abundant eosinophilic cytoplasm)
- Lack of Myofilaments (Cross-striations)
- Lack of Myofibroblastic Differentiation
- Lack of Myoglobin, Actin, Desmin, Muscle Markers

Uncertain Etiology

Association with Primitive Neuroepithelial Tumors of
Posterior and Middle Cranial Fossa in 15%

Median Age 11 months
90% of Cases <3 years of age
Oldest Case 8.5 years of age

Gender Ratio 1.5M : 1.0F

Hypercalcemia with Elevated Parathormone Levels

No Associated Syndromes

Short, Unrelenting Clinical Course:
Resistant to Chemotherapy and Radiotherapy

Usually, Die of Disease Within 1 year of Diagnosis

Metastasize Widely via Hematogenous and Lymphatic Routes

   

Malignant Rhabdoid Tumor of Kidney: Pathology

Histopathologic Patterns:

Sclerosing

  • Fibrotic
  • Osteosarcomatoid
  • Chondroid

Epithelioid

  • Trabecular
  • Mucoid
  • Alveolar
  • Storiform
  • Pseudoglandular

Spindled

  • Broad Fascicular
  • Myxoid
  • Pericytomatous
  • Storiform
  • Palisading

Lymphomatoid

  • Solid
  • Histiocytoid

 

Malignant Rhabdoid Tumor of Kidney:  
Light microscopy (A) and Ultrastructure (B)
rhabdoid tumor - lm rhabdoid tumor - em
Figure 3A: Tumor cells are characterized by eccentric nuclei, prominent nucleoli and eosinophilic cytoplasmic inclusions.  Figure 3B: Cytoplasmic intermediate filament whirls are diagnostic of the rhabdoid phenotype. 

   

Malignant Rhabdoid Tumor of Kidney: Ancillary Investigations

Immunocytochemistry:
Positive: Cytokeratin, EMA, Vimentin
Variably Positive: Neural Markers, Desmin, Actin

Ultrastructure:
Tightly Whorled Aggregates of Intermediate Filaments
Primitive Cell Junctions
Tonofilaments

Flow Cytometry: Usually Diploid

Malignant Rhabdoid Tumor of Kidney: Cytogenetics

Cytogenetic Abnormalities:
Chromosome 22(q11.2)
Chromosome 22 Monosomy and Partial Deletions
Translocation
t(11;22) and t(18;22)(q21;q11.2)
Chromosome 22 del(22)(q11)

Breakpoint Cluster Region Different from Ewings Sarcoma
Family of Tumors



INDEX
Nephroblastoma (Wilms tumor)
Congenital Mesoblastic Nephroma
Clear Cell Sarcoma
Renal Cell Carcinoma
Angiomyolipoma
Ossifying Tumor of Infantile Kidney

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