Wilms tumor with rare spinal metastasis treated with surgery and chemotherapy: A case report

Nephroblastoma, also known as Wilms tumor, is the most common type of kidney cancer found in pediatric patients. The majority of cases (75%) occur in children aged 1-5 years, with a peak incidence at approximately 3 years of age. Hematogenous spread primarily involves the lungs (81%), followed by the liver and lungs (15%) and other sites (4%). Additionally, the tumor can spread to regional lymph nodes. In contrast to clear cell sarcoma and other renal malignancies, Wilms tumor rarely metastasizes to the brain and bones. A 4-year-old boy was diagnosed with left nephroblastoma and received one round of neoadjuvant chemotherapy followed by radical removal of the left kidney. Post-surgery, he underwent seven additional cycles of chemotherapy. However, the cancer recurred 5 years and 10 months later, presenting as a rare occurrence of spinal metastasis and paraplegia in both legs. The child underwent surgery to remove the tumor from the L3 vertebra along with spinal canal and nerve root decompression, bone graft fusion, and internal fixation using a nail-rod system. Following four cycles of adjuvant chemotherapy, imaging confirmed complete remission, and his paraplegic symptoms improved significantly. However, 1 year after treatment, the child experienced tumor recurrence (bilateral lung metastasis). This case illustrates that in patients with nephroblastoma accompanied by uncommon spinal metastasis and symptoms of spinal cord compression, timely surgical intervention to alleviate the compression and remove the tumor, followed by chemotherapy can result in favorable treatment outcomes and considerably enhance the child's quality of life.