Adult Wilms' tumor: a clinicopathologic study of 11 cases

Wilms' tumor, one of the most common solid tumors in children, may also arise in the kidney of adults. We report here eleven cases seen in patients greater than 18 yr of age at The University of Texas M. D. Anderson Cancer Center, Houston. There were eight males and three females with ages ranging from 21 to 67 yr with a mean of 32 yr. Gross hematuria and/or an abdominal mass were the most common clinical presentations. The patients presented at a later stage than is typical of children (45% with stages III and IV disease), and eight of ten patients (80%) with adequate follow-up died of disease between 12 and 69 mo (mean, 30 mo; median, 25 mo), despite combined treatment with surgery, chemotherapy, and/or irradiation. Pathologically, a classic triphasic pattern was seen in seven cases and a biphasic pattern in four. None of the tumors showed features of anaplasia. Large tumor size and a high mitotic rate were associated with a poor prognosis. In contrast to cases in children, persistent renal blastema was not found in any of our cases, suggesting that the purported histogenesis of these tumors in childhood may not hold true in adults.