From Favorable Histology to Relapse: The Clonal Evolution of a Wilms Tumor.

Jason Saliba, Natasha Belsky, Ami Patel, Kristen Thomas, William L Carroll, Joanna Pierro

Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society 2020 Mar-Apr

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Favorable histology (FH) Wilms tumor (WT) is one of the most curable of all human cancers, yet a small minority of patients fail treatment. The underlying biological pathways that lead to therapy resistance are unknown. We report a case of initially unresectable, FH WT which revealed limited necrosis and persistent blastemal predominant histology following neoadjuvant chemotherapy. Despite intensification of therapy and whole abdominal radiation, the patient relapsed and succumbed to her disease. In an effort to discover candidate drivers of drug resistance, whole exome sequencing and copy number analysis were performed on samples from all 3 tumor specimens. Sequencing results revealed outgrowth of clones with a dramatically different genetic landscape including dominant mutations that could explain therapy evasion, some of which have not been previously reported in WT. Our results implicate PPM1D, previously shown to be associated with drug resistance in other tumors, as the major driver of treatment failure.

Citation

Jason Saliba, Natasha Belsky, Ami Patel, Kristen Thomas, William L Carroll, Joanna Pierro. From Favorable Histology to Relapse: The Clonal Evolution of a Wilms Tumor. Pediatric and developmental pathology : the official journal of the Society for Pediatric Pathology and the Paediatric Pathology Society. 2020 Mar-Apr;23(2):167-171