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Adult Wilms' tumor with calcification untreated for 5 years – a case report
© Masuda et al; licensee BioMed Central Ltd. 2004
Received: 06 February 2004
Accepted: 05 June 2004
Published: 05 June 2004
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.
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.
Calcification may be a sign of slow tumor gowth and possibly a favorable prognosis in cases of adult Wilms' tumor.
Wilms' tumor mostly occurs in childhood, and there are no established treatment guidelines for such tumors in adults. Whereas calcification is a common finding in cases of neuroblastoma, it is considered uncommon in Wilms' tumor. Here we describe a case of adult Wilms' tumor with calcification in a 22-year-old man, who was untreated for 5 years but made a good recovery without disease progression after surgery. Calcification may be a sign of slow tumor growth and possibly a favorable prognosis in cases of Wilms' tumor in adults.
Wilms' tumor is rare in adults, whereas it is the most common renal tumor in children. Adult Wilms' tumor may have a more aggressive clinical course and a higher tumor stage at the time of diagnosis compared with that in children . In the present case, the patient presented with a chief complaint of right flank pain, and abdominal CT revealed focal calcification at the upper pole of the right kidney. We suspected renal stones in a caliceal diverticulum, and planned further assessment including DIP, but the patient did not visit our hospital again for a further 5 years, by which time his clinical stage had progressed to stage II from stage I at the time of initial diagnosis, according to the National Wilms' Tumor Study classification. Intratumoral calcification is a common finding in neuroblastoma, but rare in Wilms' tumor . The incidence of radiographically demonstrable calcification in primary Wilms' tumor varies between 3% and 17% . It has not been clarified whether there is a significant relationship between tumor calcification and histology, grade, or patient prognosis. However, several previous reports have demonstrated that although calcified tumors may be relatively large, they tend to be localized and histologically well differentiated. This may indicate that calcified tumors are slow-growing and that calcification in Wilms' tumor may be a sign of a favorable prognosis . In the present case, the 5-year delay in treatment was unfortunate because this allowed the tumor to become large and invade the liver. However, the patient has been well without tumor recurrence for 15 months after radical surgery. This may also support the concept that calcified Wilms' tumors in adults show a low degree of aggressiveness.
Calcification in adult Wilms' tumor may be a sign of slow tumor growth and possibly a favorable prognosis.
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- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2490/4/5/prepub
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