WAGR, Sex Reversal, Bilateral Gonadoblastomas, and Intralobar Nephrogenic Rests: Uncertainties of Pre-Biopsy Chemotherapy in a High Risk Syndrome for Nephroblastoma

Background: WT1 deletions are associated with nephroblastomas, WT mutations are associated with 46, XY sex reversal. It is unclear why only a few WT1 deletions are associated with sex reversal. Case report. This 46, XY female had a 15.2 MB interstitial deletion of 11p14.1p11.2, which included WT1 an...

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Published in:Fetal and pediatric pathology 2023-01, Vol.42 (1), p.63-71
Main Authors: Craver, Randall, Stark, Matthew, Moss, Stephanie, Long, Sarah, Prasad, Pinki, C. Roth, Christopher
Format: Article
Language:English
Subjects:
Female
gonadoblastoma
Gonadoblastoma - genetics
Gonadoblastoma - pathology
Humans
Kidney Neoplasms - genetics
Kidney Neoplasms - pathology
nephroblastoma
nephrogenic rests
Ovarian Neoplasms
pre-biopsy chemotherapy
Rest
Sex-reversal
Syndrome
WAGR
Wilms Tumor - drug therapy
Wilms Tumor - genetics
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Summary:Background: WT1 deletions are associated with nephroblastomas, WT mutations are associated with 46, XY sex reversal. It is unclear why only a few WT1 deletions are associated with sex reversal. Case report. This 46, XY female had a 15.2 MB interstitial deletion of 11p14.1p11.2, which included WT1 and FSHB. No pathogenic abnormalities were identified in 156 other genes associated with disorders of sexual development. Bilateral gonadoblastomas were incidentally diagnosed at 17 months of age at the time of prophylactic gonadectomies. She was treated without biopsy for bilateral nephroblastomas radiologically identified at 18 months of age. Bilateral partial nephrectomies contained treated intralobular nephrogenic rests. Conclusion: It is unclear why WT1 deletions are less associated with 46, XY sex reversal than WT1 mutations. Treating suspected nephroblastomas without biopsy, even in patients with syndromes associated with bilateral nephroblastomas, may still lead to diagnostic and therapeutic uncertainties.
ISSN:1551-3815
1551-3823
DOI:10.1080/15513815.2022.2043962