Wilms tumor
First published on SonoWorld
Case Presentation
A previously healthy two and a half year old child presented to primary care physician with upper respiratory symptoms. On examination he was found to have an abdominal mass. An ultrasound and CT scan were performed.
![Sagittal image of the right kidney Sagittal image of the right kidney](https://legacy.123sonography.com/sites/default/files/styles/article_image/public/image/images/Sagittal%20image%20of%20the%20right%20kidney.jpg?itok=iiZZAJbv)
![Sagittal image of the right kidney (picture 2) Sagittal image of the right kidney (picture 2)](https://legacy.123sonography.com/sites/default/files/styles/article_image/public/image/images/Sagittal%20image%20of%20the%20right%20kidney%20%28picture%202%29.jpg?itok=u-9SzWZb)
![Contrast enhanced axial CT scan Contrast enhanced axial CT scan](https://legacy.123sonography.com/sites/default/files/styles/article_image/public/image/images/Contrast%20enhanced%20axial%20CT%20scan.jpg?itok=LqDW6zkQ)
![Contrast enhanced axial CT scan (picture 2) Contrast enhanced axial CT scan (picture 2)](https://legacy.123sonography.com/sites/default/files/styles/article_image/public/image/images/Contrast%20enhanced%20axial%20CT%20scan%20%28picture%202%29.jpg?itok=4unRH8if)
![Contrast enhanced axial CT scan (picture 3) Contrast enhanced axial CT scan (picture 3)](https://legacy.123sonography.com/sites/default/files/styles/article_image/public/image/images/Contrast%20enhanced%20axial%20CT%20scan%20%28picture%203%29.jpg?itok=5OEs8VhQ)
![CT scan of the chest CT scan of the chest](https://legacy.123sonography.com/sites/default/files/styles/article_image/public/image/images/CT%20scan%20of%20the%20chest.jpg?itok=zXcmfxrH)
Differential Diagnosis
Wilms tumor, duplex kidney, solitary kidney, crossed ectopia, renal contusion/laceration, acute pyelonephritis, acute obstructive nephropathy, nephroblastomatosis, mesoblastic nephroma, multilocular cystic nephroma, ADPKD, renal transplant rejection, medullary sponge kidney, xanthogranulomatous pyelonephritis, acute renal vein thrombosis
Final Diagnosis
Wilms tumor
Discussion
Introduction: Most common primary renal tumor in childhood; peak age 2-3 years; 75% occur before the age of 5
- Arises in nephrogenic blastema
- Epithelial, stromal, blastemal ( undifferentiated components)
- May contain primitive cartilage, osteoid, fat
Histology: Favorable – 88%, Cure rate – 90%
- Anaplastic – 4%: Cellular atypia, more common in older children and African Americans
- Clear cell sarcoma – 6%: “Bone metastasizing renal tumor of childhood,” Mortality – 50%, Bone mets – 40%, may be cystic
- Rhabdoid tumor – 2%, Mortality – 90%, mean age 13 months
Clinical symptoms: Abdominal mass, fever, microscopic hematuria, hypertension
Associations: Hemihypertrophy of any cause; Beckwith-Weidman Syndrome, spontaneous aniridia, increased incidence in crossed renal ectopy and horseshoe kidney
Imaging: Usually homogenous tumor with areas of necrosis, calcification is uncommon (5-10%), may have a cystic component.
Follow Up
An open biopsy was performed which confirmed the diagnosis of Wilms tumor. The patient was started on chemotherapy.