Wilms tumour

Case contributed by Dr Vincent Tatco

Presentation

Patient presented with a painless palpable mass in the left side of the abdomen.

Patient Data

Age: 5 years old
Gender: Female
X-ray

There is a soft tissue mass in the left hemiabdomen which displaces the bowel loops.

CT

There is a large lobulated heterogenous non-calcified soft tissue mass in the left kidney. The mass measures approximately 9.2 x 7.4 x 10.2 cm (AP x T x L). It shows arterial vascular supply. There are areas of non-enhancement suggestive of necrosis or cystic components. There is no extension of the mass behind the aorta. The upper portion of the mass reaches the midline. The left ureter is displaced medially but shows no wall thickening or filling defect.

The adjacent bowel loops are displaced. The pancreatic tail is effaced and also displaced towards the right. The mass abuts and partially effaces the adjacent psoas muscle.

The left renal vein and suprarenal inferior vena cava are expanded with a filling defect indicative of tumour thrombosis.  Filling defects, likely thrombi, are also seen in the infrarenal inferior vena cava and bilateral iliac arteries. 

A round non-enhancing hypodensity, likely a cyst measuring 1.9 x 1.0 cm (AP x T), is seen in the right kidney. The right ureter is unremarkable.

Histopathologic report:

Wilms tumour (nephroblastoma), multicentric, left kidney

  • tumor size: 2.8 cm in widest dimension
  • no lymphovascular invasion identified
  • renal capsule, renal vessels, hilar and ureteral margins, free of tumour
  • necrosis comprising 90% of the tumour
  • other findings:
    • mild chronic interstitial inflammation
    • renal vein stump, negative for tumor
    • endothelial wall of the inferior vena cava, negative for tumor 

Case Discussion

This is a case of Wilms tumour, also known as nephroblastoma, which is the most common solid renal mass of childhood. The patient underwent radical left nephrectomy and the diagnosis was confirmed on histopathology.

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Case information

rID: 43889
Case created: 28th Mar 2016
Last edited: 5th Jun 2017
Inclusion in quiz mode: Included

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