Renal embryonal tumor

　　Renal embryonal tumor is a malignant mixed tumor composed of epithelium and stroma, often a large solid tumor with a capsule, containing various tissues such as glands, nerves, muscles, delicate bones, and fat. The tumor grows very fast, highly malignant, and can metastasize to distant sites early. The metastatic pathways are the same as those of renal cell carcinoma, often metastasizing to lung, liver, and bones. The tumor composition is diverse, in addition to the reticulate arrangement of embryonic base cells and the formation of幼稚 renal glomerular or tubular structures, loose mucinous tissue can be seen in the stroma, and sometimes striated muscle, cartilage, bone, or fat tissue can also be seen. The occurrence of renal blastoma is related to the loss or mutation of the WT-1 gene located at 11p13.

　　Renal embryonal tumor can be hematogenously metastasized to lung, liver, bone, brain, etc. 12% to 15% of children may have congenital malformations, such as congenital iris choroidal defect, duplicated kidney, horseshoe kidney, polycystic kidney, ectopic kidney, visceral hypertrophy, umbilical hernia, macroglossia, hemihypertrophy. The clinical manifestations of adult renal embryonal tumor are similar to those of renal cell carcinoma patients, and may be accompanied by asymptomatic hematuria, flank pain, abdominal mass, and other symptoms.

　　Renal embryonal tumor is often asymptomatic and detected as a mass by family members and doctors during routine physical examinations. Common symptoms include abdominal pain, distension, anorexia, nausea and vomiting, fever, hematuria, etc. Common signs include abdominal mass, about 25% to 60% of patients have hypertension, which may be related to increased renin levels. Tumor staging: The NWTS staging is mainly based on surgical treatment and pathological findings, and the most widely used is the NWTS3 staging method. Tumor staging is:

　　Ⅰ stage: The tumor is limited to the kidney and can be completely removed; there is no ulceration before or during surgery, and there is no tumor residue at the incision margin.

　　Ⅱ stage: The tumor has spread outside the kidney and can be completely removed; there is limited spread, such as the tumor has penetrated the renal capsule to the surrounding soft tissue; there is tumor thrombus or tumor infiltration in renal extracranial blood vessels; pathological examination has been performed, or tumor extrusion has been found during surgery, but it is limited to the waist and there is no obvious tumor residue at the incision margin.

　　Ⅲ stage: There is non-hematogenous residual tumor in the abdomen, tumor metastasis is found in renal hilum or para-aortic lymph nodes through pathological examination, there is extensive tumor infiltration in the peritoneal cavity; tumor implantation is found in the peritoneum, gross or microscopic observation shows tumor residue at the incision margin; due to infiltration of surrounding important tissues, the tumor could not be completely removed.

　　Ⅳ stage: Hematogenous metastasis, such as lung, liver, bone, brain, etc.

　　The etiology of renal embryonal tumor is unknown, and there is no special prevention. Under the combined application of surgery, radiotherapy, and chemotherapy, the long-term survival rate of renal embryonal tumor has been significantly improved. For early-stage patients, the five-year survival rate is over 90%. However, for children with simple surgery or late-stage disease, the five-year survival rate is not ideal. For patients who have not复发 after five years of treatment, the chance of recurrence in the future is greatly reduced.

　　For dietary management of renal embryonal tumors, it is recommended to eat more foods that can resist renal tumors, such as turtles, Chinese softshell turtles, sea horses, sandworms, king cobras, ambergris, jellyfish, sea cucumbers, pork and beef bone marrow, water spinach, figs, bitter herbs, cucumbers, papayas, Job's tears, silkworms, pears, and honey locust seeds.

　　For dietary management of renal embryonal tumors, it is recommended to eat more foods that enhance physical fitness and improve immunity, such as sardines, shrimps, bluefish, eels, scallops, oysters, pork liver, pork kidneys, lotus seeds, walnuts, apples, kiwis, broad beans, adzuki beans, red beans, cordyceps, bee venom, sesame seeds, and so on.

　　For dietary management of renal embryonal tumors, it is recommended to eat frogs, Indian gooseberries, Job's tears, coriander, pork and beef bone marrow, broad beans, walnuts, pork kidneys, abalone, horseshoe crab, sea snake, scallops, and sea cucumber.

　　Renal embryonal tumors, like renal cell carcinoma, should be removed by nephrectomy as soon as possible once diagnosed. For large tumors, radiotherapy can be performed before surgery to shrink the tumor, which is conducive to surgery and can reduce bleeding and reduce the difficulty of surgery. Radiotherapy can be continued after the incision is healed, which can improve the cure rate. Chemotherapy can use actinomycin D, 15-25 micrograms/kg/day, administered intravenously for 5 days, repeated every 3 months, a total of 7 times. Or vincristine sulfate 40-60 micrograms/kg/day, administered intravenously, with a total dose of 100-300 micrograms/kg.

　　Under the combined application of surgery, radiotherapy, and chemotherapy, the long-term survival rate of renal embryonal tumors has significantly improved. For early-stage patients, the five-year survival rate is above 90%. However, for children with simple surgery or advanced disease course, the five-year survival rate is not ideal. The chance of recurrence after five years without recurrence after treatment is greatly reduced.