Wilms Tumor in an Adult Patient: Case Report

Abstract

INTRODUCTION: Wilms tumor or nephroblastoma is the second most common intra-abdominal cancer of childhood and the fifth most common malignant neoplasm in pediatric age. In adulthood it affects men and women equally, with a preference in the third decade of life. The differential diagnosis of Wilms tumor includes neuroblastoma and other pediatric renal neoplasms, such as clear cell sarcoma, malignant rhabdoid tumor, and renal cell carcinoma, whose prognosis is less favorable. Among the clinical manifestations of Wilms tumor are abdominal tumor, which produces abdominal pain, fever, micro or macroscopic hematuria, and arterial hypertension of renal origin due to hyperproduction of renin induced by the mass effect of the tumor. A 3 year survival of 20% is accepted for adult patients and 80% for children. OBJETIVE: To present the case of a 22 year old male patient with a diagnosis of Wilms Tumor, of importance since it is not frequent in adults as well as the clinical presentation. PRESENTATION OF CLINICAL CASE: A 22 year old male patient with a history of pain in the right lumbar region of more or less 2 weeks duration underwent renal ultrasound which showed right renal mass, so he was referred to a tertiary care hospital where urotomography was performed. A hypodense mass of irregular shape was evident at the level of the upper pole of the right kidney, which could be considered a neoplastic process. Regarding symptoms, he presented abdominal pain and in laboratory tests it reflected hemoglobin 14.9g/dl and hematocrit 45.50%. It was decided to perform right radical nephrectomy surgery, revealing a right renal tumor that occupies 95% of the renal parenchyma measuring more or less 17 x 12.5cm. Satisfactory evolution. Pathology report concluded intermediate-risk mixed nephroblastoma, with tumor necrosis and presence of lymphovascular invasion. DISCUSSION: The peak incidence of nephroblastoma occurs between 2 and 5 years of age, in adulthood, being somewhat uncommon, it affects men and women equally; However, in this case it is a 22-year-old patient, which makes it unusual. The clinical presentation of Wilms tumor is usually the presence of an asymptomatic abdominal mass, which may present rapid growth, associated with anemia, fever, weight loss, hematuria, general malaise, among others. The case presented showed a clinical picture with abdominal pain without having caused rupture of the tumor, nor was any alteration observed in laboratory studies, something out of the ordinary in terms of the symptoms and presentation described in other cases. The optimal treatment, regardless of whether or not preoperative polychemotherapy is used, consists of radical nephrectomy.  CONCLUSION: Wilms tumor is a rare pathology in adults; The treatment of choice for this pathology is radical nephrectomy combined with chemotherapy and radiotherapy in childhood. In adult patients, the benefit of treatment with chemotherapy and radiotherapy is still unknown; it will always depend on the histopathological grade.