Help a caveman out

[Homunculus]

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recently had a pt with what appeared to be (clinically and via CT) a classic wilm's tumor. good deal, easily treated. pathological ID took a long time, we got nervous, and sure enough it comes back neuroblastoma.

so edumacate me. are the two in the same differential list? how similar are they under the 'scope?

yeah, i could look it up, but you guys can filter out the not so pertinent stuff more easily than i can. 🙂

--your friendly neighborhood inquisitive caveman

 

[garfield]

Absolutely they are in the differential. And yes, you could look it up and see it for yourself. Can look quite similar under the microscope, especially if you get a teeny-tiny biopsy or cytology (worthless). Wilms' classically has three components: blastema, mesenchymal, and epithelial. And blastema are small, round cells like neuroblastoma. The tubules (epithelial of Wilms') can be ill-defined and look like neuroblastoma rosettes. And you can have neural elements in Wilms too. Ancillary studies can help like immunohistochem, cytogenetics, EM (sort of old-fashioned), checking for serum/urinary catecholamines.