Wilms' tumor: Difference between revisions
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==Background== | ==Background== | ||
*Affects children < | *Affects children <15yr, 2/3 of cases diagnosed before age 5<ref>https://www.uptodate.com/contents/presentation-diagnosis-and-staging-of-wilms-tumor?search=wilms%20tumor%20children&source=search_result&selectedTitle=1~120&usage_type=default&display_rank=1</ref> | ||
*Arises from persistent embryonal renal cells | *Arises from persistent embryonal renal cells | ||
*Most common renal malignancy in children<ref>https://www.uptodate.com/contents/presentation-diagnosis-and-staging-of-wilms-tumor?search=wilms%20tumor%20children&source=search_result&selectedTitle=1~120&usage_type=default&display_rank=1</ref> | |||
*10-15% will have mets at presentation (lungs) [[File:Wilms.jpg|thumbnail]] | *10-15% will have mets at presentation (lungs) [[File:Wilms.jpg|thumbnail]] | ||
*10% of cases are associated with malformation syndromes such as WAGR, Denys-trash, Beckwith-Wiedemann<ref>https://www.uptodate.com/contents/presentation-diagnosis-and-staging-of-wilms-tumor?search=wilms%20tumor%20children&source=search_result&selectedTitle=1~120&usage_type=default&display_rank=1</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
*Abdominal swelling/mass | *Abdominal swelling/mass, can have abdominal pain | ||
**Avoid vigorous palpation to prevent capsular rupture | **Avoid vigorous palpation to prevent capsular rupture; causes tumor spillage (will then need more intensive therapy) | ||
*Subcapsular hemorrhage presents as abdominal enlargement, anemia, HTN, and possibly fever | |||
*Patient often appears well | *Patient often appears well | ||
*Less frequent features include [[abdominal pain (peds)|abdominal pain]], [[hematuria (peds)|hematuria]], [[fever ( | *Less frequent features include [[abdominal pain (peds)|abdominal pain]], [[hematuria (peds)|hematuria]], [[fever (Peds)|fever]], anorexia, [[nausea and vomiting (peds)|nausea/vomiting]], [[hypertension]]<ref>https://www.merckmanuals.com/professional/pediatrics/pediatric-cancers/wilms-tumor</ref> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[neuroblastoma (peds)|Neuroblastoma]] | *[[neuroblastoma (peds)|Neuroblastoma]] | ||
*Other renal cell tumors are rare in children | |||
==Evaluation== | ==Evaluation== | ||
*[[ultrasound: Abdomen|Ultrasound]] or CT | *[[ultrasound: Abdomen|Ultrasound]], CT or MRI | ||
*CBC, chemistry, [[LFTs]], coags | *Chest imaging to look for lung mets, usually CT | ||
*CBC, chemistry including serum calcium and creatinine, [[LFTs]], coags | |||
==Management== | ==Management== | ||
*Consult oncology/surgery | *Consult oncology/surgery | ||
*Surgery, chemo, and/or radiation | *Surgery/biopsy, chemo, and/or radiation based on staging | ||
==Disposition== | ==Disposition== | ||
*Admission | *Admission for further workup and management | ||
==References== | ==References== | ||
Latest revision as of 21:15, 20 April 2022
Background
- Affects children <15yr, 2/3 of cases diagnosed before age 5[1]
- Arises from persistent embryonal renal cells
- Most common renal malignancy in children[2]
- 10-15% will have mets at presentation (lungs)
- 10% of cases are associated with malformation syndromes such as WAGR, Denys-trash, Beckwith-Wiedemann[3]
Clinical Features
- Abdominal swelling/mass, can have abdominal pain
- Avoid vigorous palpation to prevent capsular rupture; causes tumor spillage (will then need more intensive therapy)
- Subcapsular hemorrhage presents as abdominal enlargement, anemia, HTN, and possibly fever
- Patient often appears well
- Less frequent features include abdominal pain, hematuria, fever, anorexia, nausea/vomiting, hypertension[4]
Differential Diagnosis
- Neuroblastoma
- Other renal cell tumors are rare in children
Evaluation
- Ultrasound, CT or MRI
- Chest imaging to look for lung mets, usually CT
- CBC, chemistry including serum calcium and creatinine, LFTs, coags
Management
- Consult oncology/surgery
- Surgery/biopsy, chemo, and/or radiation based on staging
Disposition
- Admission for further workup and management
References
- ↑ https://www.uptodate.com/contents/presentation-diagnosis-and-staging-of-wilms-tumor?search=wilms%20tumor%20children&source=search_result&selectedTitle=1~120&usage_type=default&display_rank=1
- ↑ https://www.uptodate.com/contents/presentation-diagnosis-and-staging-of-wilms-tumor?search=wilms%20tumor%20children&source=search_result&selectedTitle=1~120&usage_type=default&display_rank=1
- ↑ https://www.uptodate.com/contents/presentation-diagnosis-and-staging-of-wilms-tumor?search=wilms%20tumor%20children&source=search_result&selectedTitle=1~120&usage_type=default&display_rank=1
- ↑ https://www.merckmanuals.com/professional/pediatrics/pediatric-cancers/wilms-tumor