Journal of

Case Reports and Images in Oncology

 
     
Case Report
 
Wilms tumor with multiple bone and lung metastases in a two-year-old boy
Putu Diah Vedaswari1, Ketut Ariawati1
1Department of Child Health, Medical School of Udayana University, Denpasar, Bali, Indonesia

Article ID: 100041Z10PV2017
doi:10.5348/Z10-2017-41-CR-12

Address correspondence to:
Putu Diah Vedaswari
Denpasar, Bali
Indonesia
80119

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How to cite this article
Vedaswari PD, Ariawati K. Wilms tumor with multiple bone and lung metastases in a two-year-old boy. J Case Rep Images Oncology 2017;3:52–56.


ABSTRACT
Introduction: Wilms tumor is the most common renal tumor encountered in children with more than 80% was diagnosed below the age of five years. The incidence of metastases of Wilms tumor is approximately 10%. The primary distant site for metastases is the lung; hepatic and lymph nodal metastases are much less common and bone metastases being extremely rare.
Case Report: We present a two year-old boy with masses on the head, right shoulder and right knee with history of palpable masses two month before on his left abdomen and underwent a nephrectomy. The microscopic examination after tumor excision showed unfavorable Wilms tumor but he never went for chemotherapy. Chest X-ray revealed a solitary nodule on the right paracardiac region and the destruction of the right scapular bone very likely the process of metastases. Computed tomography scan of head revealed soft tissue masses and destructed bone underneath. Microscopic examination in biopsy of the masses at head and right shoulder revealed hypercellular groups of neoplastic cells suitable for small round cell tumor suggests a metastasis of Wilms tumor. He planned to have 24 weeks of chemotherapy consist of doxorubicin, vincristine, cyclophosphamide, and etoposide. After 17 weeks of treatment, he experienced clinical improvement.
Conclusion: Metastases to the bone and lung in Wilms tumor are extremely rare. The manifestation can be as a mass with destructed bone underneath with cytomorphology suitable for small round cell tumor.

Keywords: Bone metastases, Children, Lung metastases, Wilms tumor


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Author Contributions
Putu Diah Vedaswari – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ketut Ariawati – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2017 Putu Diah Vedaswari et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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