TITLE: A RARE CASE OF BILATERAL WILMS’ TUMOR STAGE V IN A 3/M

AUTHORS: DR. RAUL MARTIN BRIEN C. ANDUTAN, DR. JACKELINE O. LAO M.D, DR. PAUL NIMROD B. FIRAZA, DPBU

NORTHERN MINDANAO MEDICAL CENTER

KEY WORDS: BILATERAL WILMS TUMOR, NEPHRECTOMY

ABSTRACT

INTRODUCTION AND OBJECTIVE:

Synchronous bilateral Wilms’ tumors occur in 5% to 7% of children with Wilms tumor. On our literature
search this is the second reported case of Bilateral Wilms’ Tumor in the Philippines, a previous case was reported in
PGH in 1993.

Pa ent presented with a chief complaint of gradually enlarging abdominal mass for 10 months. CT scan of
WA with contrast was done no ng a Bilateral hypodense, lobulated, mixed solid cys c, with heterogenously
enhancing renal masses, primary considera on is Bilateral Wilms Tumor. Neoadjuvant chemotherapy for 6 weeks
using the COG protocol was ini ated. Post 6 weeks chemo, noted signi cant decrease in size in the right tumor,
however the le tumor was unresponsive showing an increase in size. Another 6 weeks of chemo was suggested to
improve resectability of the right mass for par al nephrectomy, right. However, no improvement was seen post 12
weeks of chemotherapy. Renal Nephrometry score was 12a, indica ng High Complexity and a 21.9% likelihood of
major complica on for par al nephrectomy on the right. Renal GFR scan was done with the right kidney showing
an adequate renal func on of 52.2 ml/min, normal serum Crea nine of 0.3. Pa ent was prepared for Radical
Nephrectomy Le , Open Renal Biopsy Right. Pa ent is planned to con nue chemotherapy post op once with biopsy
results to improve resectability of the right.

METHODS:

Pa ent was placed on supine posi on, a transverse incision was made carried down to the peritoneum.
Mobiliza on of the le colon was done to access the le tumor. Dissec on was then done across across all the
surface of the tumor. The le ureter was then iden ed and ligated. Further dissec on was made in the medial
aspect un l the Le renal vein was iden ed and isolated. Subsequently the le renal artery was iden ed and
isolated. Liga on was then done and the mass was successfully extracted. Open biopsy was then performed on the
right tumor. Pa ent tolerated procedure well, monitored in the PICU and then subsequently transferred to the
ward.

RESULTS:

In this study, radical nephrectomy was done at the le due to its unresectability and unresponsiveness to
chemotherapy. For the Right tumor, par al nephrectomy was planned but due to the High complexity score of 12a
on RENAL Nephrometry score, consensus during MDT was to priori ze preserva on of the right kidney func on,
perform an open biopsy rst and then con nue chemotherapy to improve the resectability. Post adjuvant
chemotherapy, resectability of tumor will be reaassed and de ni ve plan is to do par al nephrectomy, right.

CONCLUSIONS:
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 The case emphasizes the complexity of the management of Bilateral Wilms’ tumor and the importance of
a mul disciplinary approach. We present a case of Bilateral Wilms Tumor Stage V s/p Neoadjuvant Chemotherapy
12 cycles s/p Radical Nephrectomy, Le , Open biopsy, Right. On our literature search this is the 2nd reported case of
bilateral Wilms’ Tumor in the Philippines.
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