PDF-531.pdf 439Vol. 9 | No. 1 | Winter 2012 |U R O LO G Y J O U R N A L Keywords: collision tumor, cystic nephroma, neuroblastoma, childhood INTRODUCTION Acollision tumor is present when two distinct primary tumors are found and a neuroblastoma. CASE REPORT - symptoms. On her physical examination, a mass at the right upper lateral abdo- men nearly 7 × 6 cm in diameter was palpated. Her past and family histories were unremarkable. The abdominal ultrasonography and tomography scan revealed a 93 × 75 × 81 mm mass in the right renal localization, which had a smooth surface and multiple septae with solid and cystic areas. The 24-hour urine sample examination revealed increased amounts of vanilylmandelic acid and homovanilic acid (2.8 mg/day and within normal limits. Right radical nephrectomy was performed and a mass at the inferior region of the right adrenal gland was removed. The renal tumor was well circumscribed with - Ceyhun Bozkurt,1 Ulya Ertem,1 Sema Apaydın,2 Ferda Şenel,3 Gürses Şahin,1 Nazmiye Yüksek,1 Sonay İncesoy Özdemir,1 Esin Boduroğlu2 Coexistence of Cystic Nephroma and Neuroblastoma A Rare Case of a Childhood Collision Tumor Corresponding Author: Ceyhun Bozkurt, MD Department of Pediat- ric Oncology, Dr. Sami Ulus Children’s Hospital, İlkbahar Mah. 590. sok. No: 9/7, 06550, Çankaya, Ankara, Turkey Tel: + 90 312 305 6061 Fax: + 90 312 317 0353 E-mail: bozkurt.ceyhun@ gmail.com Received January 2010 Accepted June 2010 1 Department of Pediatric Oncology, Dr. Sami Ulus Children’s Hospital, An- kara, Turkey 2 Department of Patholo- gy, Dr. Sami Ulus Children’s Hospital, Ankara, Turkey 3 Department of Urology, Dr. Sami Ulus Children’s Hospital, Ankara, Turkey Case Report 440 | mm. The cut surface of the tumor was multicystic with non-communicating cysts that varied in size from a few millimeters to 4 cm. The other was soft, mm in size. On microscopic examination, the cysts were lined - differentiated tubules (Figure 1). The surrounding kidney tissue showed minimal mesangial prolifera- tion and tubule epithelium with no evidence of any other dysplastic lesions. No blastemal rest or other precursor lesions of Wilms tumor were encoun- tered. Microscopic examination of the other tumor in the inferior region of the adrenal gland revealed all stages of neuronal differentiation throughout the tumor. The tumor had a lobular appearance between the groups of tumor cells, and was com- posed of sheets of small cells with hyperchromatic nuclei and scanty cytoplasm. Between the tumor cells were immature, multinucleated, or complete- ly abnormal ganglion cells that were placed either seen between the masses of cells. to express synaptophysin and chromogranin (Fig- because of technical problem. This pathologic di- agnosis was well differentiated neuroblastoma and for nine years. DISCUSSION Neuroblastic tumors are mainly originated from primordial neural crest cells that generate adrenal medulla and sympathetic ganglia. and cystic, partially-differentiated nephroblastoma on the benign end and polycystic Wilms tumor on the malignant end.(1,2) There are two peaks in the incidence of the tumor, one in the childhood and one in the middle age. Most childhood cases occur between the ages of 3 months and 2 years and 73% of the subjects are male. The second peak consists (3) neoplasms were reported.(4) unknown.(5) painless abdominal mass(6) nephroma may also cause infection, hypertension, and pain.(7) Pre-operative diagnosis with radiological methods may be imprecise or even inadequate.(8) Some au- thors suggest that ultrasonography is better than computed tomography in terms of showing inter- (9) childhood has previously been reported as coexist- ent mesoblastic nephroma and neuroblastoma, (12) - mor,(13) and neuroblastoma and nephroblastoma.(14) Nisen and colleagues have reported a 2.5-year-old - roblastoma on the left kidney.(15) But in our patient, both tumors were on the same side. Vegunta and associates have discussed the etiology of collision Figure 1. Cystic nephroma which consists of varied size cysts and septae (hematoxylin and eosin, × 80) Case Report 441Vol. 9 | No. 1 | Winter 2012 |U R O LO G Y J O U R N A L Coexistence of Cystic Nephroma and Neuroblastoma | Bozkurt et al tumors and proposed that a common tumorigenic stimulus triggers the neoplastic transformation of different cell types and their tumorigenic develop- ment. We propose that therapy for collision tu- mor must be designed for both tumors if they have a malignant component. CONFLICT OF INTERESTS None declared. REFERENCES 1. Joshi VV, Beckwith JB. Multilocular cyst of the kidney (cystic nephroma) and cystic, partially differentiated nephro- blastoma. Terminology and criteria for diagnosis. Cancer. 1989;64:466-79. 2. Sacher P, Willi UV, Niggli F, Stallmach T. Cystic nephroma: a rare benign renal tumor. Pediatr Surg Int. 1998;13:197-9. 3. Madewell JE, Goldman SM, Davis CJ, Jr., Hartman DS, Feigin DS, Lichtenstein JE. 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Nisen PD, Rich MA, Gloster E, et al. N-myc oncogene expres- sion in histopathologically unrelated bilateral pediatric re- nal tumors. Cancer. 1988;61:1821-6. Figure 2. (A) Diffuse synaptophysin staining in neoplasm, antisynaptophysin (× 200). (B) Chromogranin positive areas of the neoplasm, anti-chromogranin (× 200) A B