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Microscopic examination showed bone involvement with a small blue cell tumor with tubule formation and a stromal component (A, B – H&E, 40X and 100X). Occasional mitoses were observed (C, green circle – H&E, 400X ). The tumor cells stained positive for PAX-8 (D) and negative for S100, p63, and WT-1, supporting the diagnosis of metastatic Wilms tumor.
