Presentation
Painless palpable mass in the left side of the abdomen.
Patient Data
There is a soft tissue mass in the left hemiabdomen which displaces the bowel loops.
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 tumor thrombosis. Filling defects, likely thrombi, are also seen in the infrarenal inferior vena cava and bilateral iliac veins.
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 tumor (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 tumor
- necrosis comprising 90% of the tumor
- 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 tumor, 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.