Acute lymphoblastic leukemia mimicking Wilms tumor at presentation
Amitabh Singh1, Anirban Mandal2, Vijay Guru2
1Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi.
The Gulf Journal of Oncology
|February 14, 2017
Summary
A rare case of childhood acute lymphoblastic leukemia (ALL) presented as kidney and liver masses with normal blood counts, initially mimicking Wilms tumor. WT1 positivity can occur in ALL, highlighting diagnostic challenges.
Area of Science:
- Pediatric Oncology
- Hematology
- Diagnostic Imaging
Background:
- Acute lymphoblastic leukemia (ALL) is the most common childhood cancer, often presenting atypically.
- Nephromegaly (enlarged kidneys) and hepatic masses are rare manifestations of childhood ALL.
Observation:
- A 3-year-old child presented with a unilateral renal mass and hepatic mass, with initially normal blood counts.
- Initial investigations, including imaging and WT1 positivity on renal mass immunocytochemistry, suggested metastatic Wilms tumor.
- Subsequent flow cytometry and bone marrow examination confirmed a diagnosis of ALL.
Findings:
- WT1 positivity is not exclusive to Wilms tumor and can be observed in childhood ALL.
- Complete blood counts in acute leukemia can be deceptively normal at presentation.
- Renomegaly in acute leukemia may not always be due to leukemic infiltration.
Implications:
- This case highlights the diagnostic challenges posed by rare presentations of ALL.
- Radiological differentials for renal masses in children should include hematological malignancies.
- WT1 positivity requires careful interpretation in the context of other clinical and laboratory findings.
