Korean J Urol.  2012 Apr;53(4):288-292.

Wilms' Tumor with Long-delayed Recurrence: 25 Years after Initial Treatment

• Lee SY
• Kim KR
• Park JY
• Ro JY

Abstract

Wilms' tumor is one of the most frequent malignant neoplasms in childhood. Advances in treatment modalities such as the combination of chemoradiation therapy with surgery have enhanced overall survival. However, recurrence of Wilms' tumor is still a problem. In this case, a 28-year-old female had experienced intermittent abdominal pain, and the computed tomography scan showed a huge pelvic mass. The patient had a history of radical nephrectomy for Wilms' tumor with concurrent chemotherapy at the age of three. The pelvic mass was resected in February 2010 and was confirmed to be a recurrent Wilms' tumor. The recurrent tumor showed a classic triphasic Wilms' tumor growth pattern with frequent mitoses and tumor necrosis. Our case is an extraordinary case of a long-delayed recurrent Wilms' tumor after 25 years, which is the longest disease-free interval ever reported. The possible effects of chemotherapy as well as some other mechanisms of this late relapse are discussed.

Keyword

Drug therapy; Late recurrence; Therapeutics; Wilms tumor

MeSH Terms

Abdominal Pain
Adult
Female
Humans
Mitosis
Necrosis
Nephrectomy
Recurrence
Wilms Tumor

Figure

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  FIG. 1 Computed tomographic finding showing a huge mass with enhancing solid portion involving almost the entire lower abdominal cavity.

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  FIG. 2 Grossly, the recurrent 30-cm mass had a yellowish pink to red, firm and lobulating cut surface with focal hemorrhage and necrosis.

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  FIG. 3 (A) Microscopically, the recurrent tumor showed a classic triphasic growth pattern with blastemal, epithelial, and mesenchymal components (H&E, ×40). (B) Hypercellular blastemal element with adjacent tumor necrosis (H&E, ×40). (C) Short spindle mesenchymal cells in myxoid background (H&E, ×400). (D) Epithelial component with tubular growth pattern (H&E, ×400). (E) Undifferentiated blastemal cells with frequent mitoses (H&E, ×400).

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  FIG. 4 (A) Immunohistochemical staining of cytokeratin showing positivity in the epithelial component (×400). (B) Immunohistochemical staining of Ki-67 showing 50% positivity in tumor cells (×200).

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