Case history

Case history

A previously healthy, 3-year-old female patient presents with progressive abdominal distension and left, upper quadrant prominence. On examination the mass is firm, smooth, non-tender, and does not cross the mid-line. The patient is also found to have moderate hypertension. Urinalysis reveals microscopic haematuria.

Other presentations

Less common presentations include abdominal pain, fever, haematuria, or anaemia.[5] Pain and anaemia may alert to the possibility of tumour rupture. Bilateral or multifocal tumours may be detected in around 5% to 10% of patients and may present at an earlier age.[4]​​[6]​ Very rarely, an extrarenal Wilms' tumour may occur, for example, in the retroperitoneum, pelvic cavity (uterus), inguinal region, testes, thorax, or within teratomas.[7][8][9]​​ Shortness of breath or hepatomegaly may indicate metastatic disease.[4] Rarely, children may present with a paraneoplastic syndrome that affects the central and peripheral nervous system (e.g., generalised weakness, fatigue, ptosis, hypokinesis, dysarthria, urinary retention, facial diplegia, ophthalmoplegia, and autonomic dysfunction).[10] Intracardiac extension of Wilms' tumour occurs in <5% of Wilms' tumour cases.[11] Patients with predisposing syndromes may be diagnosed through regular surveillance.[12] Wilms' tumours may present in adolescents and adults.[13][14]

Use of this content is subject to our disclaimer