Management of bilateral Wilms' tumour: A case report. (2020)

• Record Type: Journal Article
• Authors: Wahyudi, Irfan; Aritonang, Johannes; Hamid, Agus Rizal A.H.; Situmorang, Gerhard R.; Mirza, Hendy; Widia, Fina; Rodjani, Arry
• Is Part Of: International journal of surgery case reports. Volume 77(2020)
• Page Start: 53
• Page End: 56
• Publication Date: 2020
• Subjects: Bilateral Wilms' tumour -- Chemotherapy -- Renal sparing surgery -- Nephrectomy -- Adjuvant radiotherapy; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.10.057
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Wilms' tumor is the most prevalent kidney tumor, accounting for 6% of all pediatric malignancies, 5–7% being bilateral case. Cases about a 19-month-old boy diagnosed as stage V Wilms tumor based on SIOP and NWTSG classification. Neoadjuvant chemotherapy regimen followed by the right partial, left radical nephrectomy, and adjuvant radiotherapy. No specific guideline on follow-up and imaging timing; we do regular follow-up every 12 months and periodic MRI imaging. Abstract: Introduction: Wilms' tumour remains the most common renal tumour in children (6% of all pediatric malignancies) and present as one of the most challenging tasks for paediatric urologists as its management requires an advanced procedure. The ultimate goal in these cases is to preserve as much renal parenchyma as possible whilst still achieving complete tumour resection. Presentation of case: Here we present a six year follow up report of a bilateral Wilms' tumour case in a 19-months old boy. This patient underwent neoadjuvant chemotherapy regimen, followed by right partial nephrectomy and left radical nephrectomy. Adjuvant radiotherapy was performed following the surgery. Follow-up imaging 5 months afterward revealed a firmly heterogeneous cystic lesion consist of fat and calcification at the upper pole of the right kidney, none of which created any problem for the patient. MRI was later performed on the 19 th month after the surgery, showing marked decrease in the size of the cyst. Discussion: According to SIOP and NWTSG classification, the patient presented as stage V of the disease. The patient was on neoadjuvant chemotherapy (Regimen I) as recommended by NWTSG. This strategy was shown to be effective, as the tumour on the left kidney was reduced to less than 70% of the initial size. A routine follow-up using chest x-ray, abdominal ultrasonography (USG), and contrast studies such as MRI and MSCT scan, was performed in our reports. Conclusion: From our experience, the combination of neo-adjuvant chemotherapy, renal salvage surgery and adjuvant radiotherapy is a feasible, safe and effective option for bilateral Wilms' tumour cases.