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Intrarenal neuroblastoma masquerading as Wilms' tumor
O J Kessler1, J F Siegel, W A Brock
1Department of Urology, Schneider Children's Medical Center of Israel, Petah Tiqva.
Objectives:
To better characterize intrarenal neuroblastoma.
Methods:
We retrospectively reviewed the records of 5 children with neuroblastoma initially diagnosed as Wilms' tumor.
Results:
Five patients, aged 11 months to 3.5 years, were preoperatively diagnosed as having intrarenal Wilms' tumor, prior to operative or histopathologic diagnosis of neuroblastoma. In 3 children the diagnosis of neuroblastoma involving the kidney was confirmed; in the fourth child subcutaneous metastatic disease precluded biopsy confirmation of the intrarenal tumor; and in the fifth child the kidney was severely displaced but not actually involved by neuroblastoma. All patients were hypertensive and 4 patients had elevated urinary catechol levels. Molecular genetic studies showed N-myc amplification in both patients who were evaluated. All patients had poorly differentiated histopathology. One patient is presently alive at 8 months with recurrent disease and another patient is free of disease 13 years after diagnosis. The remaining 3 patients died of the malignancy.
Conclusions:
Intrarenal neuroblastoma is a rare entity that clinically and radiographically may resemble Wilms' tumor. Our limited experience indicates that intrarenal neuroblastoma is an aggressive malignancy, and long-term survival is rare.