title: Hyperplastic perilobar nephroblastomatosis: long-term survival of 52 patients.
abstract: BACKGROUND
  This study provides insight into the clinical behavior, diagnostic complexities, and long-term management of patients with hyperplastic perilobar nephroblastomatosis (HPLN).
  
  
  METHODS
  Fifty-two patients with HPLN with available long-term follow-up were retrospectively analyzed for pathologic, radiologic, and clinical features.
  
  
  RESULTS
  The mean age at diagnosis was 16 months; the lesions were bilateral in 49 patients. Of 33 patients who initially underwent diagnostic biopsy and adjuvant chemotherapy, 18 (55%) developed Wilms tumor (WT) at a mean of 35 months from diagnosis. Of 16 patients whose initial therapy included nephrectomy and adjuvant therapy, three (19%) developed WT at a mean of 36 months from diagnosis. All three patients who underwent initial diagnostic biopsy and received no adjuvant therapy during their initial course developed WT 4, 4, and 10 months following diagnosis. 24/52 patients developed either a single (13 patients) or multiple (11 patients) WT throughout their course; 8/24 (33%) of WT were anaplastic. The time from initial diagnosis to the development of the last WT ranged from 13 to 116 months (mean 42 months). Three children with HPLN died of WT at 3, 5, and 6 years of age; 2/3 were anaplastic.
  
  
  CONCLUSIONS
  HPLN is a self-limited, pre-neoplastic proliferative process associated with a high risk of developing WT. The accurate diagnosis and the choices of therapy during the often-complex course of HPLN depend on the availability and accurate interpretation of a combination of pathologic, radiologic, and clinical information. When such information is appropriately obtained, the long-term survival of patients with HPLN is excellent.
authors.affiliation: Department of Pathology, Children's Memorial Medical Center and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University's Feinberg School of Medicine, Chicago Illinois 60614, USA. eperlman@childrensmemorial.org
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Perlman
authors.forename: Paulo
authors.initials: P
authors.lastname: Faria
authors.forename: Andreia
authors.initials: A
authors.lastname: Soares
authors.forename: Fred
authors.initials: F
authors.lastname: Hoffer
authors.forename: Simone
authors.initials: S
authors.lastname: Sredni
authors.forename: Michael
authors.initials: M
authors.lastname: Ritchey
authors.forename: Robert C
authors.initials: RC
authors.lastname: Shamberger
authors.forename: Daniel
authors.initials: D
authors.lastname: Green
authors.forename: J B
authors.initials: JB
authors.lastname: Beckwith
mesh_terms: D017024:Chemotherapy, Adjuvant / Q000379:methods; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D009392:Nephrectomy / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D009396:Wilms Tumor / Q000401:mortality / Q000473:pathology* / Q000628:therapy*