A 43-year-old woman was admitted to the hospital with
left flank pain. The physical examination revealed a left abdominal
mass. Laboratory test results identified normochromic-
normocytic anemia (hematocrit, 33%; hemoglobin,
10.8 g/dL; and mean corpuscular volume, 88 fL) and
microscopic hematuria (10 red blood cells per high-power
Ultrasonography and a CT scan of the abdomen
demonstrated a large, solid tumor in the left kidney. The
angiogram depicted a hypovascular tumor. A radical
nephrectomy was performed via the transabdominal approach;
pathologic examination of the resected mass
confirmed Wilms tumor.
Wilms tumor, or nephroblastoma, is the most common
solid renal tumor that occurs in children; it is rarely
seen in adults. The neoplasm develops from remnants
of the primitive metanephric blastema of the immature
kidney. Alterations in a region on the short arm of chromosome
11 (11p13) have been implicated in the tumor's
Surgery and chemotherapy with or without radiotherapy
are options; the choice depends on tumor stage
and histologic type. Despite its rare occurrence in adults,
Wilms tumor needs to be included in the differential diagnosis
of all renal masses.
This patient's neoplasm was a stage 2 malignancy--
tumor extends beyond the kidney and is completely
excised with no residual tumor at or beyond the margins
of the excision--according to the National Wilms Tumor
Study classification.1 Adjuvant chemotherapy with vincristine-
actinomycin D was given. The patient remains free of
disease 45 months after the surgery.
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.)