Wilms' tumor. Role of fine needle aspiration and DNA ploidy by image analysis in prognostication.
OBJECTIVE
To evaluate the utility of cytomorphologic features and DNA ploidy estimation in fine needle aspirates (FNAs), from Wilms' tumors for prognostication.


METHODS
Twenty-three cases of Wilms' tumor having FNA and follow-up data were selected. Cytomorphology was analyzed by two observers. DNA ploidy was determined in 19 cases by image cytometry by destaining Papanicolaou-stained slides and restaining with Feulgen stain. Various parameters and patient outcomes were compared, and statistical evaluation was done.


RESULTS
Poor outcome (12/23 cases) was associated with age < 2 years (P = .01), severe pleomorphism of blastemal cells (4/23 cases, P < .05), very large nucleoli (5/23 cases, P = .075), atypical mitosis (6/23 cases, P = .032) and aneuploidy/tetraploidy of tumor cells (6/29 cases, P = .005). Term unfavorable cytology is proposed when a combination of severe pleomorphism, very large nucleoli and atypical mitosis is seen in FNA smears. Four Wilms' tumor FNAs were characterized as showing unfavorable cytology, and all had a poor outcome (P = .0351). Three of the six cases with aneuploid/tetraploid features also showed unfavorable cytology.


CONCLUSIONS
Unfavorable cytology and aneuploidy/tetraploidy in FNA smears of Wilms' tumor are associated with a poor prognosis.
Iyer
V K
VK
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Kapila
K
K
Agarwala
S
S
Dinda
A K
AK
Verma
K
K
D000367:Age Factors; D000782:Aneuploidy; D001707:Biopsy, Needle / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004247:DNA / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019044:Image Cytometry / Q000379:methods*; D008297:Male; D008938:Mitosis; D011003:Ploidies; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000473:pathology* / Q000628:therapy
D004247:DNA