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[Metachronous bilateral Wilms' tumor].

M Mambié Meléndez1, M Guibelalde Del Castillo, N Nieto Del Rincón

  • 1Servicio de Pediatría. Hospital Universitario Son Dureta. Palma de Mallorca. Baleares, Spain. mariannamambie@hotmail.com

Anales Espanoles De Pediatria
|February 28, 2002
PubMed
Summary

Metachronous Wilms' tumor, a rare recurrence of kidney cancer, presents unique challenges. Early chemotherapy is crucial for preserving kidney function and avoiding dialysis in affected children.

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Area of Science:

  • Pediatric Oncology
  • Nephrology

Background:

  • Wilms' tumor is the most common primary malignant tumor of the kidney in children.
  • Metachronous Wilms' tumor, occurring after a disease-free interval, is rare, accounting for 2-3% of cases.
  • Most metachronous recurrences (96.2%) appear within 5 years of the primary tumor diagnosis.

Observation:

  • A rare case of metachronous Wilms' tumor relapse occurred 7 years after the initial diagnosis in an 11-year-old girl with left hemihypertrophy.
  • The patient underwent preoperative chemotherapy and tumorectomy, followed by nephrectomy of her only kidney due to post-surgical complications.
  • This resulted in the patient becoming anephric, leading to chronic renal failure and dependence on dialysis.

Findings:

  • Treatment with carboplatin and etoposide was continued post-surgery, leading to complete remission.

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  • The case highlights the rarity of metachronous Wilms' tumor appearing more than 5 years after the primary diagnosis.
  • Chemotherapy is vital for reducing tumor size to preserve renal function and prevent dialysis when contralateral tumors develop.

    • Implications:

    • Metachronous Wilms' tumor necessitates tailored treatment strategies to balance oncological outcomes and renal function preservation.
    • For patients with end-stage renal disease due to bilateral nephrectomy, dialysis support combined with carefully selected chemotherapeutic agents is essential.
    • Understanding drug pharmacokinetics and pharmacodynamics is critical for managing anephric patients undergoing cancer treatment.