Management of bilateral Wilms' tumour: A case report
Irfan Wahyudi1, Johannes Aritonang1, Agus Rizal A H Hamid1
1Department of Urology, Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
Insights
Bilateral Wilms' tumour management in a child utilized neoadjuvant chemotherapy, partial nephrectomy, and radiotherapy. This combined approach proved safe and effective for preserving renal parenchyma and achieving tumour resection.
Area of Science:
- Pediatric Oncology
- Urology
- Nephrology
Background:
- Wilms' tumour is the most common pediatric renal malignancy, posing significant management challenges.
- The primary objective in Wilms' tumour treatment is complete resection with maximal renal parenchyma preservation.
- Bilateral Wilms' tumour requires advanced surgical and oncological strategies.
Observation:
- A case report details a 19-month-old boy with bilateral Wilms' tumour (Stage V).
- The patient received neoadjuvant chemotherapy, followed by right partial nephrectomy and left radical nephrectomy.
- Post-surgery, a benign cystic lesion was noted on the right kidney, which decreased in size over time.
Findings:
- Neoadjuvant chemotherapy effectively reduced tumour size by over 70% in the left kidney.
- The combined treatment strategy of neoadjuvant chemotherapy, renal salvage surgery, and adjuvant radiotherapy was employed.
- Routine follow-up included imaging studies like MRI and MSCT scans.
Implications:
- The presented multimodal approach is feasible, safe, and effective for bilateral Wilms' tumour.
- This strategy highlights successful organ-sparing management in pediatric renal malignancies.
- This case contributes to understanding long-term outcomes and management of complex pediatric cancers.
Introduction:
Wilms' tumour remains the most common renal tumour in children (6% of all pediatric malignancies) and present as one of the most challenging tasks for paediatric urologists as its management requires an advanced procedure. The ultimate goal in these cases is to preserve as much renal parenchyma as possible whilst still achieving complete tumour resection.
Presentation Of Case:
Here we present a six year follow up report of a bilateral Wilms' tumour case in a 19-months old boy. This patient underwent neoadjuvant chemotherapy regimen, followed by right partial nephrectomy and left radical nephrectomy. Adjuvant radiotherapy was performed following the surgery. Follow-up imaging 5 months afterward revealed a firmly heterogeneous cystic lesion consist of fat and calcification at the upper pole of the right kidney, none of which created any problem for the patient. MRI was later performed on the 19th month after the surgery, showing marked decrease in the size of the cyst.
Discussion:
According to SIOP and NWTSG classification, the patient presented as stage V of the disease. The patient was on neoadjuvant chemotherapy (Regimen I) as recommended by NWTSG. This strategy was shown to be effective, as the tumour on the left kidney was reduced to less than 70% of the initial size. A routine follow-up using chest x-ray, abdominal ultrasonography (USG), and contrast studies such as MRI and MSCT scan, was performed in our reports.
Conclusion:
From our experience, the combination of neo-adjuvant chemotherapy, renal salvage surgery and adjuvant radiotherapy is a feasible, safe and effective option for bilateral Wilms' tumour cases.
