A 3-year-old girl was referred in June 1965 with a right sided abdominal mass which was felt the previous day by her pediatrician at a routine office visit. An I.V.P. showed a normal left kidney with duplex collecting system, but a mass in the lower pole of the right kidney with distortion of the collecting system of the kidney consistent with Wilms tumor. Negative chest film. Cystoscopy under anesthesia revealed one normal ureteral orifice on each side. Retrograde pyelogram on the right duplicated the I.V.P. findings.
Fig. 1. Intravenous Pyelogram (Select Image for High-quality Version). (Left) Duplex collecting system with normal calyceal architecture. (Right) Calyces distorted by Wilms tumor of lower pole.
With a cut down in the right arm a right 9th interspace thoracoabdominal incision was made. The colon was reflected medially. The mass and all perinephric tissue were freed from the retroperitoneum, ligating and dividing 2 renal arteries and veins with the aorta and vena cava. Perivascular lymph nodes appeared negative. This was later confirmed microscopically.
The tumor was of moderate size. No blood transfusion was needed. Her first injection of Actinomycin-D was given intraoperatively. The opposite kidney was negative on palpation. A first postoperative radiation treatment was given the next day. After a postoperative conference on the 5th day with all physicians caring for the patient, the decision was made to withhold further radiation treatment and chemotherapy because:
- All gross tumor had been removed
- All lymph nodes studied were negative
- All specimen margins were clear
The patient was discharged 11 days postop. She was a normal healthy child until age 10 years when a ruptured appendix was removed.
When last seen in 2012, at age 50 years (47 years postop) the patient was a healthy, athletic (Boston Marathon), married woman, working productively in business.