Monophasic Wilms' tumor with multiple skeletal metastases in a young female: A case report and review of literature

Wilms' tumor (nephroblastoma) is the most common renal tumor in children. It is uncommon in adolescent and skeletal metastasis at the time of presentation is even rare. The present case is a rare monophasic blastemal variant of Wilms' tumor presenting with multiple skeletal metastases in a young female. We report a case of 23-year-old female presented with severe low backache and colicky right loin pain of 1 month and constant dull aching left upper arm pain of 20 days duration. Contrast-enhanced computed tomography (CECT) abdomen revealed heterogeneously enhancing soft tissue density mass with central nonenhancing areas arising from the upper pole of the right kidney. Whole body 18F-Sodium Fluoride (NaF) Positron emission tomography-computed tomography (PET/CT) bone scintigraphy revealed multiple skeletal metastases. The patient underwent right radical nephrectomy and the tumor was confirmed as adult Wilms' tumor by histopathology and immunohistochemistry. Skeletal metastasis may be the first presentation in a case of adolescent Wilms' tumor, and this possibility should be considered when an adolescent patient presents with flank pain and a renal mass. The clinical course of adult Wilms' tumor with blastemal component is very aggressive with high chances of recurrence and mortality.


Heidi Seqers, Marry M van den HeuvelEibrink, Kathy Pritchard-Jones, et al. Management of adults with Wilms' tumor: recommendations based on international consensus. Expert Rev Anticancer Ther. 2011; 11(7):1105-13.

Shahla Ansari, Ghasem MiriAliabad, Naser Rakhshani. Bilateral Wilms' Tumor Metastasis to Right Spermatic Cord. Int J Hematol Oncol Stem Cell Res. 2013; 7(4): 45-48.

Lin F, Krishnamurthy S. Fine needle aspiration cytology of a skeletal metastasis of adult Wilms' tumor. A case report. Acta Cytol. 2001; 45(3):393-8.

Adolphs HD, Knopfel G, Vogel J. Wilms tumor in the adolescent and adult. Eur J Urol 1983;9: 281-7.

Elwira Szychot,John Apps,Kathy Pritchard-Jones. Wilms' tumor: biology, diagnosis and treatment. Transl Pediatr 2014; 3(1):12-24.

Jay Krishnan, Jerome Pietras, Marcella Nachmann,Gordon Brown. Adult Wilms' Tumor with a Unique Presentation of High-Grade Fever, Photophobia, and Headache. Rev Urol. 2012; 14(1-2): 31-34.

Patil TV, Patel KM, Shukla SN, Parikh BJ, Anand AS, Shah MS. Adult Wilms' tumour. Indian J Med Paediatr Oncol. 2008;29(4):37-40.

Ebb DH, Green DM, Shamberger RC, Tarbell NJ. Solid tumors of childhood. In Cancer principles and practice of oncology. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2005.

Hyeon Joo Jeong, Kwang Hwa Park, Hyung Ki Choi, Ki Hwang Kim et al. Adult Wilms' tumor: a case report. Yonsei Med J. 1989; 30(1):88-94.

Rashmi Patnayak, D. V. S. Rambabu, Amitabh Jena, Bodagala Vijaylaxmi et al. Rare case of blastemal predominant adult Wilms' tumor with skeletal metastasis case report and brief review ofliterature. Indian J Urol. 2012; 28(4): 447-449.

Kaynak Göster