Wilms' Tumor


Step 1: View clinicals

A 19 month old girl presents with a lump in the upper abdomen, which her mother noticed while bathing her earlier today. There was no history of fever, abdominal pain, nausea, vomiting or weight loss. No urinary or bowel symptoms were present. Her antenatal, birth, postnatal and family histories are all unremarkable. The full blood count, urinalysis, and renal functions and electrolytes are all normal.

Step 2: Order all relevant investigations

Ultrasound Abdomen

There is a solid mass 7.0 x 4.0 x 3.5 cm in size, which is continuous with the pelvis of the right kidney. No calcifications are noted.

MRI + MRA Abdomen

There is a 70mm x 43mm x 36mm heterogeneous mass involving the pelvis of the right kidney, which is hypointense in T1-scans and hyperintense in T2-scans. There is no evidence of vascular extension or venous thrombosis. Capsular invasion is not noted.

Doppler of Renal Vasculature

The right renal vein and inferior vena cava appear normal, with no evidence of vascular invasion or thrombosis.

Contrast CT Thorax

The CT scan of the thorax is completely normal.

Step 3: Select appropriate management

Neoadjuvant Radiotherapy
Genetic Screening of Family
Neoadjuvant Chemotherapy
R/s Nephrectomy

Score: ★★☆