Wilm's Tumor

Question 1

What is the most common primary malignant renal tumor?

Answer 1

Wilms’ Tumor

Question 2

Wilms tumor is more common in _____, while neuroblastoma is more common in _____.

Answer 2

Blacks

Whites

Question 3

How would you describe the pathophysiology of Wilms tumor?

Answer 3

• Rapidly growing soft kidney mass, cystic, vascular, friable, often with pseudocapsule
• Can be solitary or multifocal tumors, unilateral or bilateral

Question 4

Two types of wilms tumor

Answer 4

• Favorable (blastemal, stromal, or epithelial)

- Anaplastic

Question 5

Anaplastic histology

Answer 5

Assocsiated with a higher relapse rate and less favroable prognosis

Question 6

What stage is bilateral Wilms?

Answer 6

Stage V

Question 7

How does a patient present with Wilms tumor?

Answer 7

• Asymptomatic abdominal mass in well child
• Macroscopic or gross hematuria (PAINLESS)
• HTN in 25% of cases
• Abd pain, malaise, anorexia, vomiting, anemia

Question 8

Diagnostic workup of Wilms

Answer 8

Complete HP (note locastion, size of mass, presence of GU anomalies
such as hypospadias, cryptorchidism)
- CBC, renal and liver fxn studies, chemistries, UA
-US and CT scan of abdomen
-Chest CT
-Tumor tissue (nephrectomy)

Question 9

Where is the most common site of metastasis of Wilms tumor?

Answer 9

Lungs

Question 10

What do we need ot be careful of with surgical intervention with Wilms tumor?

Answer 10

Pseudocapsule, high rate of recurrent if tumor spillage into abdomen during surgery

Question 11

Prognostic factors

Answer 11

Favorable histology is positive prgonostic factor

• Younger = better
• Tumor size

Question 12

Poor prognostic factors

Answer 12

• Metastatic disease at dx
• Lymph node involvement
• Early recurrence
• Increased age at dx
• Anaplastic histology