Neuroblastoma vs Wilms tumor

Last revised by Henry Knipe on 13 Oct 2021

Both neuroblastoma and Wilms tumor occur in early childhood and typically present as large abdominal masses closely related to the kidneys. Distinguishing between the two is important, and a number of features are helpful.


  • calcification very common: 90%
  • encases vascular structures but does not invade them
  • younger age group (<2 years of age)
  • poorly marginated
  • elevates the aorta away from the vertebral column
  • more commonly crosses the midline, especially behind the aorta 2 
  • more common to have extension into the chest
  • bone metastases are common (Hutchinson syndrome)
  • extension into spinal canal can be seen
  • retroperitoneal lymph nodes are more often seen

Wilms tumor

  • calcification uncommon: 10-15% (10% rule of Wilms tumor)
  • displaces adjacent structures without insinuating between them, also with displacement of the renal vessels
  • slightly older age group: peak 3-4 years of age
  • well-circumscribed
  • claw sign with the kidney
  • extension into IVC/renal vein
  • bone metastases are rare, rather lung metastases are common
  • extension into spinal canal never seen
  • retroperitoneal lymphadenopathy is uncommon
  • higher incidence of hemorrhage

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Cases and figures

  • Figure 1
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  • Case 1: neuroblastoma
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  • Case 2: Wilms tumor
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