Symptoms and Diagnosis of Wilms' Tumor

The most common symptom of Wilms tumor in children is the asymptomatic appearance of a palpable tumor (61.6%). Often a new growth is detected when the child is examined in the absence of any complaints (9.2%). In addition, macrohematuria (15.1%), constipation (4 3% decrease in body weight (3.8%) of urinary infection (3.2%) and diarrhea (3.2%) are also possible.Wilms' tumor symptoms in children - nausea, vomiting, pain, the appearance of abdominal hernia with a large tumor and an increase in blood pressure.

[1], [2], [3], [4], [5]

Diagnosis of Wilms tumor

Examination of a child with suspected Wilms tumor should include laboratory tests and radiological studies.

[6]

Laboratory diagnosis of Wilms tumor

• General blood test;
• biochemical blood test, including determination of the concentration of creatinine, urea, electrolytes and calcium in blood serum;
• evaluation of coagulogram;
• general urine analysis;
• cytogenetic study for deletion of 11p13 with WAGR syndrome, duplication of paternal allele 11p15 with Beckwith-Wiedemann syndrome, mutation of WT1 gene with Denys-Drash syndrome.

Instrumental diagnosis of Wilms tumor

• Ultrasonography of the kidneys, kidney vessels, inferior vena cava, abdominal organs.
• CT of the abdomen and thoracic cavity.
• CT scan of the abdominal cavity will clarify the organ of the tumor. The condition of the lymph nodes of the retroperitoneal space and the abdominal cavity, the contralateral kidney (for bilateral lesion), the renal and inferior vena cava (for tumor venous thrombosis) and the liver (to exclude metastases).
• CT of the thoracic cavity (if CT revealed a focal lung injury, not detectable by radiography, biopsy of nodules should be recommended).
• Radiography of the lungs (4 fields), aimed at detecting metastases (patients with metastases to the lungs, visualized by radiography, are shown the irradiation of all lungs).

Histological confirmation of the diagnosis of Wilms tumor is mandatory. In North America, patients with suspected Wilms tumor immediately underwent nephrectomy with regional lymph node biopsy according to the clinical programs of the Wilms National Cancer Research Group. Regional lymph dissection is not an obligatory standard, but a number of researchers routinely remove regional lymph nodes to all patients. In North America, immediate nephrectomy is performed only in patients with bilateral tumors. In contrast, most European centers establish a clinical diagnosis, based only on the data of radiation survey methods. Clinical Centers of Europe, members of the International Society of Pediatric Oncology (SIOP), prior to nephrectomy, all patients undergo chemotherapy.

A percutaneous biopsy for verification of the diagnosis is not indicated, since it can lead to the development of undesirable complications and aggravates the course of the disease.

Patients with negative radiography of light and positive CT results require biopsy of focal lesions and confirmation of their metastatic nature, since pathological changes in the lung tissue (histoplasmosis, atelectasis, pseudotumor, intrapulmonary lymph nodes, pneumonia) can stimulate Wilms tumor metastases into the lungs.

The main diagnostic signs of Wilms tumor in children are a non-homogeneous or solid kidney tumor with cystic inclusions and hypodensitive zones, the tumor has a clear contour without signs of infiltration of surrounding tissues. Characteristic destruction, deformation and displacement of cups and pelvis. With intravenous bolus contrasting, an increase in non-homogeneity of the tumor structure is noted in CT and MRI. Signs of hemorrhages in the tumor are often met (27% of observations). On the contrary, calcinates are extremely rare (about 8% of observations).

Differential diagnosis of Wilms tumor

Children need to distinguish Wilms tumor from neuroblastoma: in addition, a differential diagnosis is made with lymphoma, teratoma, cystic nephroma, hamartoma, hamatoma, kidney carbuncle, xanthogranulomatous pyelonephritis.

[7], [8], [9]

Complications of Wilms tumor

The incidence of postoperative complications is 12.7%. The most common complications of Wilms' tumor are small intestinal obstruction (5.1%), bleeding (1.9%) and wound suppuration (1.9%). Additional treatment after nephrectomy can lead to damage to certain organs (heart, lungs, liver, bones, sex glands). Both chemotherapy and radiotherapy can induce the development of secondary tumors.

Chronic renal failure in patients treated for Wilms tumor is noted Rarely. Its development is facilitated by the removal of the functioning renal parenchyma, as well as postoperative irradiation.

Congestive heart failure may be a consequence of the appointment of tetracyclines, which requires monitoring of heart function in patients receiving doxorubicin.

Getting lungs in patients with pulmonary metastases may complicate the development of pneumosclerosis and respiratory failure. The total and vital capacity of the lungs after irradiation can be reduced by 50-70% of the initial

Hepatotoxicity of Wilms tumor treatment is caused by two factors: irradiation and administration of dactinomycin. The frequency of decrease in liver function is 2.8-14.3%. In some cases, the development of acute thrombosis of the hepatic veins, leading to the development of appropriate symptoms.

Irradiation of the abdominal cavity leads to sclerotic changes in sexual glands and, as a result, a decrease in fertility after reaching reproductive age. Development of insufficiency of hormonal function of sexual glands is also promoted by the use of alkylating drugs.

Irradiation of the abdominal cavity is also associated with impaired bone growth, in particular - the spine, which causes the development of scoliosis.

Conducting chemotherapy involving doxorubicin, dactinomycin and vincristine, as well as irradiation lead to an increased risk of developing secondary malignant tumors. 15 years after the diagnosis, the probability of a secondary neoplasm is 1.6 ° / Treatment of recurrences of a Wilms tumor increases this index by 4-5 times.

The most common localization of recurrences is mild. In addition, it is possible to damage the bed of the removed kidney (1/4 relapse).

Bones and the brain are common zones of recurrence in patients with a favorable histological variant of the tumor.

[10], [11], [12], [13]