Patient Case Discussion
Case Summary
3-Year-Old's Abdominal Mass Diagnosis
This is the case of a 3-year-old child from West Africa, a recent immigrant to Canada. The child had an increased abdominal extension and a palpable renal mass, leading to a differential diagnosis of Wilm's tumor, neuroblastoma, hepatoblastoma, retroperitoneal lymphoma, and large lymphoma. The first intervention was an ultrasound in the emergency room, which was discussed.
Wilms Tumor Case Discussion
The child was suspected of having Wilms tumor, a type of kidney cancer. The tumor was large and multilobulated, with possible extra capsular extension. The renal artery and vein were patent, with no tumor thrombus. The child's hypertension was mentioned as a relevant factor. The next steps for the patient were not clearly outlined. The moderator, Dr. Sherif Emil, inquired about how other colleagues' practices, particularly whether they would typically start with chemotherapy or surgery.
Surgical Procedure for Resectable Tumor
A surgical procedure was discussed for a resectable tumor, which involved a nephrectomy and the placement of a border catheter. The tumor was large but was successfully dissected out without significant spillage. The procedure involved isolating the artery, vein, and ligating them, as well as transecting the ureter. The renal vein and renal artery were ligated. There was a discussion about whether genetic studies should be performed prior to intervention, with it being suggested that due to the time it takes to get results, decisions are based primarily on imaging. The possibility of nephron sparing surgery was also discussed, noting that it would not be easily possible in this case.
Wilms Tumor With Unique Cystic Pattern
The surgical team discussed a case of a large kidney tumor weighing 500 grams, which was quite distorted and compressed the normal kidney. The tumor had a triphasic pattern, consistent with a favorable histology Wilms tumor. The tumor involved the renal sinus and ureter, with a unique cystic pattern. Noted was the importance of looking for nephrogenic rests in such cases, as they can be associated with overgrowth syndromes or other conditions. The presence of a small area with an appearance similar to the tumor remained an open question.