Wilms Tumor in an Adult

A 43-year-old woman was admitted to the hospital withleft flank pain. The physical examination revealed a left abdominalmass. Laboratory test results identified normochromic-normocytic anemia (hematocrit, 33%; hemoglobin,10.8 g/dL; and mean corpuscular volume, 88 fL) andmicroscopic hematuria (10 red blood cells per high-powerfield).Ultrasonography and a CT scan of the abdomendemonstrated a large, solid tumor in the left kidney. Theangiogram depicted a hypovascular tumor. A radicalnephrectomy was performed via the transabdominal approach;pathologic examination of the resected massconfirmed Wilms tumor.Wilms tumor, or nephroblastoma, is the most commonsolid renal tumor that occurs in children; it is rarelyseen in adults. The neoplasm develops from remnantsof the primitive metanephric blastema of the immaturekidney. Alterations in a region on the short arm of chromosome11 (11p13) have been implicated in the tumor'sdevelopment.Surgery and chemotherapy with or without radiotherapyare options; the choice depends on tumor stageand histologic type. Despite its rare occurrence in adults,Wilms tumor needs to be included in the differential diagnosisof all renal masses.This patient's neoplasm was a stage 2 malignancy--tumor extends beyond the kidney and is completelyexcised with no residual tumor at or beyond the marginsof the excision--according to the National Wilms TumorStudy classification.¹ Adjuvant chemotherapy with vincristine-actinomycin D was given. The patient remains free ofdisease 45 months after the surgery.

References:

REFERENCE:

1.

Ritchey M. Pediatric urologic oncology. In: Walsh PC, ed.

Campbell’s Urology.

Philadelphia: WB Saunders Company; 2002.(Case and photograph courtesy of Drs C. Bouropoulos and D. Papaioannides.)