I just read on CNN.com the other day the story of a little 2-year-old boy with a massive Wilm's tumo r (approximately 5 kilograms). Sponsored by the Ray Tye Medical Aid Foundation , his parents took him to Jordan to have the surgery. The media declared it a success and left it at that. The pictures show a small boy with a massively distended abdomen. The skin surface shows venous congestion, caput medusae? or striae? Imagining the size of that thing, he must be having trouble breathing, let alone walking or eating or anything else. Now that it is "out", what are the risks of recurrence in this young lad? What are the prognostic factors in Wilm's tumor? Wilms tumor is the most common primary malignant renal tumor of childhood. The North American approach is to resect the untreated primary tumor then give chemotherapy based on the pathologic analysis. The European approach is to give preoperative chemo, resect, then provide post op chemotherapy. The first cons...