Adult-onset nephroblastoma in a male patient: a case report

Nephroblastoma, also known as Wilms tumor, is one of the most common malignancies diagnosed in children. Contrarily, the incidence in adults is only 0.2 cases per million people annually. As such, there are no standardized guidelines for clinical management in adults.

This case describes an adult male in his twenties who presented to the emergency department with 1 week of intermittent hematuria and right flank pain. Imaging unexpectedly revealed a large, radiographically abnormal-appearing mass in the upper pole of the right kidney. The decision was made to biopsy the mass to assist with decisions regarding intervention in case neoadjuvant chemotherapy was indicated. This was later pathologically found to be consistent with nephroblastoma (Wilms tumor). The patient underwent adrenal-sparing right radical nephrectomy with regional lymph node dissection followed by adjuvant chemotherapy with vincristine and dactinomycin. Prior to this, he underwent testicular sperm extraction (TESE) due to azoospermia and fertility concerns. He tolerated this well and has had no evidence of disease on surveillance imaging 9 months postoperatively.

This case report provides unique insight into specific diagnostic and intraoperative surgical considerations for abnormal adult presentation of nephroblastoma. Specifically, we discuss the role of preoperative biopsy for consideration of neoadjuvant therapy and the role of adrenal-sparing and lymph node sampling. We highlight this in the context of the current literature available regarding the management of adult nephroblastoma.