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Wilm's Tumor
Nephroblastoma
General Considerations
- Most common abdominal malignancy of children
- Both kidneys affected synchronously or metachronously in 5-10%
- Peak incidence at 2.5-3 years
- More common in blacks than whites with an approximately equal gender distribution
Clinical Findings
- Asymptomatic abdominal mass most common
- Abdominal pain
- Hematuria
- Hypertension
- Urinary tract infection
- Varicocele
- Aniridia
- Hemihypertrophy
- Beckwith-Wiedemann Syndrome
Imaging Findings
- Ultrasound is frequently the first study
- CT is useful in determining extent, lymph nodes and liver metastases
- Tumors tend to be large and may cross midline
- Sharply marginated possibly with compressed normal renal tissue
- May be partially cystic from necrosis
- Curvilinear or punctate calcifications
- Invasion of IVC by tumor
- Hypervascular tumors
- On MRI, tumor tends to have decreased signal on T1 and increased on T2
Differential Diagnosis
- Neuroblastoma
- Polycystic kidney disease
- Rhabdomyosarcoma
Treatment
- Nephrectomy followed by chemotherapy
- Postoperative radiation therapy for stage II and IV lesions
Complications
- Impaired renal function following nephrectomy is rare
- Chemotherapeutic agents may be hepatotoxic
- Scoliosis following radiation therapy
Prognosis
Wilm's Tumor. Conventional radiograph of abdomen shows a large right upper mass displacing
bowel loops into the pelvis and across the midline (blue arrows). Coronal and sagittal reformatted CT
demonstrate a large, heterogeneous mass arising from the right kidney (white arrows). A small
sliver of functioning right kidney is seen to enhance (yellow arrow).
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