Wilm's tumor: Symptoms, Diagnosis & Treatments
Symptoms
A clinical presentation of Wilm 's tumor occurs in 25% of hypertension patients with an increase in renin activity caused by compression of the enlarged mass with asymptomatic abdominal mass. In addition, gross painless hematuria, fever, and anemia may be caused by bleeding of pelvis or parenchyma, and tumor thrombus may block inferior vena cava. The patient was admitted to the emergency room with abdominal pain with LLQ abdominal mass, and Wilm 's tumor was diagnosed on follow - up.
Diagnosis
The diagnosis of Wilm's tumor is made using various imaging modalities. CT can be used to detect an intrarenal origin mass and distinguish it from the adrenal mass neuroblastoma. Wilm's tumor may also cause hydronephrosis, hemorrhage, necrosis, etc., while causing renal pelvic obstruction. Doppler US can identify renal vein or IVC tumor thrombus. Chest CT should be used to confirm pulmonary metastasis and to confirm before surgery whether the atelectasis or effusion is due to surgery or not. Magnetic resonance imaging (MRI) and computed tomography (CT) can be used to identify whether clear cell sarcoma has progressed to bone metastasis through a bone scan, and whether rhabdoid tumor or clear cell sarcoma has been brain spreading. In addition, Wilm's tumor lesion is an area where metabolism is active. Therefore, the signal uptake is increased through PET-CT, and histopathologic results can be confirmed by nephrectomy. In general, biopsy is not recommended because it can be up-staged.
The patient was treated with Lt. Posterior pararenal space seeding, retroperitoneal LN metastasis, Lt. Obturator LN metastasis.
Treatments
Wilm 's tumor is divided into two groups: chemo after surgical treatment and surgical treatment after chemo. Both methods have advantages and disadvantages. Early surgery allows accurate diagnosis and staging, and preoperative chemotherapy reduces the risk of rupture or hemorrhage by facilitating surgery. Surgery involves radical nephrectomy and sampling is necessary even if no abnormal lymph nodes are seen. Partial nephrectomy can be performed to prevent renal failure when there is a bilateral tumor or unilateral tumor + predisposing syndrome (eg Denys-Drash, WAGR). This patient underwent radical lt.nephrectomy and planned chemotherapy and radiotherapy for the remaining kidney function reserve. In chemotherapy, three anticancer drugs (vincristine, doxorubicin, actinomycin D) are administered for stage III and IV patients. This is called the DD4A regimen. The patient had pathologic findings of diffuse cellular anaplasia in 11% of Wilm 's tumor, and vincristine, cyclophosphamide, doxorubicin, etoposide, carboplatin and ifosfamide + radiation therapy were given to intensive chemotherapy regimen because of poor prognosis. The patient is currently treated with vincristine, cyclophosphamide and doxorubicin as an I regimen.
A clinical presentation of Wilm 's tumor occurs in 25% of hypertension patients with an increase in renin activity caused by compression of the enlarged mass with asymptomatic abdominal mass. In addition, gross painless hematuria, fever, and anemia may be caused by bleeding of pelvis or parenchyma, and tumor thrombus may block inferior vena cava. The patient was admitted to the emergency room with abdominal pain with LLQ abdominal mass, and Wilm 's tumor was diagnosed on follow - up.
Diagnosis
The diagnosis of Wilm's tumor is made using various imaging modalities. CT can be used to detect an intrarenal origin mass and distinguish it from the adrenal mass neuroblastoma. Wilm's tumor may also cause hydronephrosis, hemorrhage, necrosis, etc., while causing renal pelvic obstruction. Doppler US can identify renal vein or IVC tumor thrombus. Chest CT should be used to confirm pulmonary metastasis and to confirm before surgery whether the atelectasis or effusion is due to surgery or not. Magnetic resonance imaging (MRI) and computed tomography (CT) can be used to identify whether clear cell sarcoma has progressed to bone metastasis through a bone scan, and whether rhabdoid tumor or clear cell sarcoma has been brain spreading. In addition, Wilm's tumor lesion is an area where metabolism is active. Therefore, the signal uptake is increased through PET-CT, and histopathologic results can be confirmed by nephrectomy. In general, biopsy is not recommended because it can be up-staged.
The patient was treated with Lt. Posterior pararenal space seeding, retroperitoneal LN metastasis, Lt. Obturator LN metastasis.
Treatments
Wilm 's tumor is divided into two groups: chemo after surgical treatment and surgical treatment after chemo. Both methods have advantages and disadvantages. Early surgery allows accurate diagnosis and staging, and preoperative chemotherapy reduces the risk of rupture or hemorrhage by facilitating surgery. Surgery involves radical nephrectomy and sampling is necessary even if no abnormal lymph nodes are seen. Partial nephrectomy can be performed to prevent renal failure when there is a bilateral tumor or unilateral tumor + predisposing syndrome (eg Denys-Drash, WAGR). This patient underwent radical lt.nephrectomy and planned chemotherapy and radiotherapy for the remaining kidney function reserve. In chemotherapy, three anticancer drugs (vincristine, doxorubicin, actinomycin D) are administered for stage III and IV patients. This is called the DD4A regimen. The patient had pathologic findings of diffuse cellular anaplasia in 11% of Wilm 's tumor, and vincristine, cyclophosphamide, doxorubicin, etoposide, carboplatin and ifosfamide + radiation therapy were given to intensive chemotherapy regimen because of poor prognosis. The patient is currently treated with vincristine, cyclophosphamide and doxorubicin as an I regimen.
