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Adult Wilms' tumor with calcification untreated for 5 years--a case report.

Masuda H, Azuma H, Nakajima F, Watsuji T, Katsuoka Y - BMC Urol (2004)

Bottom Line: He had been initially referred to our hospital with a chief complaint of right flank pain 5 years previously, when abdominal computed tomography had revealed focal calcification at the upper pole of the right kidney.Although we planned further assessment, he did not revisit our hospital again until 5 years later, again because of right flank pain.Ultrasound and computed tomography scan revealed a large mass lesion with calcification in the right kidney, invasive to the hepatic lobe.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hirakata City Hospital, Hirakata, Osaka 569-8686, Japan. m3255makiko@r2.dion.ne.jp

ABSTRACT

Background: Wilms' tumor is rarely found in adults and there are no established treatment guidelines for such tumors in adults. Whereas calcification is a common finding in neuroblastoma, it is considered uncommon in Wilms' tumor.

Case presentation: We report a case of adult Wilms' tumor with calcification in a 22-year-old man. He had been initially referred to our hospital with a chief complaint of right flank pain 5 years previously, when abdominal computed tomography had revealed focal calcification at the upper pole of the right kidney. Although we planned further assessment, he did not revisit our hospital again until 5 years later, again because of right flank pain. Ultrasound and computed tomography scan revealed a large mass lesion with calcification in the right kidney, invasive to the hepatic lobe. The patient underwent curative right nephrectomy and partial right hepatic lobectomy. Pathological analysis demonstrated a nephroblastoma (Wilms' tumor) with predominant epithelial histology infiltrating the hepatic lobe. The patient has been well without tumor recurrence for 15 months after surgery.

Conclusions: Calcification may be a sign of slow tumor growth and possibly a favorable prognosis in cases of adult Wilms' tumor.

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Macroscopic appearance of the tumor The tumor is encapsulated with calcification (arrows), and shows invasion to the hepatic lobe.
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Figure 2: Macroscopic appearance of the tumor The tumor is encapsulated with calcification (arrows), and shows invasion to the hepatic lobe.

Mentions: A 17-year-old man with a chief complaint of right flank pain was referred to our hospital. Abdominal computed tomography (CT) revealed focal calcification at the upper pole of the right kidney (Fig. 1-a). We suspected renal stones in a caliceal diverticulum, and planned further assessment including drip infusion pyelography (DIP). However, because the patient became asymptomatic, he made no further visits to our hospital for 5 years. At the age of 22 years, however, he presented again because of right flank pain. DIP demonstrated focal calcification at the upper pole of the right kidney, and ultrasound (US) and CT scan demonstrated a large right renal mass with calcification invading the hepatic lobe (Figs. 1-b, and 1-c). Selective renal arterial angiography demonstrated a hypovascular tumor in the same area where the mass lesion had been observed by US, DIP, and CT. The patient underwent curative right nephrectomy and partial right hepatic lobectomy under a diagnosis of malignant renal tumor. The upper pole of the extirpated kidney was occupied by the tumor, which adhered tightly to the liver. The mass was completely removed along with the hepatic lobe, without rupture. No other invasion or lymph node metastasis was found. Macroscopic examination showed an encapsulated tumor with calcification that had infiltrated hepatic lobe (Fig. 2). The specimen weighed 280.0 g. The cut surface was solid and homogeneously white-yellow. Pathological analysis demonstrated a nephroblastoma (Wilms' tumor) with a predominantly epithelial histology that had infiltrated the hepatic lobe. The disease was classified as stage II according to the National Wilms' Tumor Study classification. After surgery, the patient received adjuvant chemotherapy with vincristine-actinomycin D for 60 weeks. He has been well without tumor recurrence for 15 months after surgery.


Adult Wilms' tumor with calcification untreated for 5 years--a case report.

Masuda H, Azuma H, Nakajima F, Watsuji T, Katsuoka Y - BMC Urol (2004)

Macroscopic appearance of the tumor The tumor is encapsulated with calcification (arrows), and shows invasion to the hepatic lobe.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC425587&req=5

Figure 2: Macroscopic appearance of the tumor The tumor is encapsulated with calcification (arrows), and shows invasion to the hepatic lobe.
Mentions: A 17-year-old man with a chief complaint of right flank pain was referred to our hospital. Abdominal computed tomography (CT) revealed focal calcification at the upper pole of the right kidney (Fig. 1-a). We suspected renal stones in a caliceal diverticulum, and planned further assessment including drip infusion pyelography (DIP). However, because the patient became asymptomatic, he made no further visits to our hospital for 5 years. At the age of 22 years, however, he presented again because of right flank pain. DIP demonstrated focal calcification at the upper pole of the right kidney, and ultrasound (US) and CT scan demonstrated a large right renal mass with calcification invading the hepatic lobe (Figs. 1-b, and 1-c). Selective renal arterial angiography demonstrated a hypovascular tumor in the same area where the mass lesion had been observed by US, DIP, and CT. The patient underwent curative right nephrectomy and partial right hepatic lobectomy under a diagnosis of malignant renal tumor. The upper pole of the extirpated kidney was occupied by the tumor, which adhered tightly to the liver. The mass was completely removed along with the hepatic lobe, without rupture. No other invasion or lymph node metastasis was found. Macroscopic examination showed an encapsulated tumor with calcification that had infiltrated hepatic lobe (Fig. 2). The specimen weighed 280.0 g. The cut surface was solid and homogeneously white-yellow. Pathological analysis demonstrated a nephroblastoma (Wilms' tumor) with a predominantly epithelial histology that had infiltrated the hepatic lobe. The disease was classified as stage II according to the National Wilms' Tumor Study classification. After surgery, the patient received adjuvant chemotherapy with vincristine-actinomycin D for 60 weeks. He has been well without tumor recurrence for 15 months after surgery.

Bottom Line: He had been initially referred to our hospital with a chief complaint of right flank pain 5 years previously, when abdominal computed tomography had revealed focal calcification at the upper pole of the right kidney.Although we planned further assessment, he did not revisit our hospital again until 5 years later, again because of right flank pain.Ultrasound and computed tomography scan revealed a large mass lesion with calcification in the right kidney, invasive to the hepatic lobe.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Hirakata City Hospital, Hirakata, Osaka 569-8686, Japan. m3255makiko@r2.dion.ne.jp

ABSTRACT

Background: Wilms' tumor is rarely found in adults and there are no established treatment guidelines for such tumors in adults. Whereas calcification is a common finding in neuroblastoma, it is considered uncommon in Wilms' tumor.

Case presentation: We report a case of adult Wilms' tumor with calcification in a 22-year-old man. He had been initially referred to our hospital with a chief complaint of right flank pain 5 years previously, when abdominal computed tomography had revealed focal calcification at the upper pole of the right kidney. Although we planned further assessment, he did not revisit our hospital again until 5 years later, again because of right flank pain. Ultrasound and computed tomography scan revealed a large mass lesion with calcification in the right kidney, invasive to the hepatic lobe. The patient underwent curative right nephrectomy and partial right hepatic lobectomy. Pathological analysis demonstrated a nephroblastoma (Wilms' tumor) with predominant epithelial histology infiltrating the hepatic lobe. The patient has been well without tumor recurrence for 15 months after surgery.

Conclusions: Calcification may be a sign of slow tumor growth and possibly a favorable prognosis in cases of adult Wilms' tumor.

Show MeSH
Related in: MedlinePlus