Wilms tumor
I just read on CNN.com the other day the story of a little 2-year-old boy with a massive Wilm's tumor (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 consideration is stage. Was the tumor confined to the kidney or completely resected. Were there positive margins, was there evidence of invasion into blood vessels? Were there local or distant metastases? These are the questions that the media does not ask, but as pathologists we must answer in order to provide the best and most current care to our patients. Stage, presence or absence of anaplasia or metaplasia are all important predictive and prognostic factors that the guide the clinicians in their choices for treatment and therapy. I've only seen a couple of WT so far and they were only 500 grams and pretty darn huge. This young boys life may be prolonged by a generous group of strangers, but will they also help provide the follow up care and chemo that he needs to make a complete recovery, or will they vanish like the media now that the tumor is "out".
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 consideration is stage. Was the tumor confined to the kidney or completely resected. Were there positive margins, was there evidence of invasion into blood vessels? Were there local or distant metastases? These are the questions that the media does not ask, but as pathologists we must answer in order to provide the best and most current care to our patients. Stage, presence or absence of anaplasia or metaplasia are all important predictive and prognostic factors that the guide the clinicians in their choices for treatment and therapy. I've only seen a couple of WT so far and they were only 500 grams and pretty darn huge. This young boys life may be prolonged by a generous group of strangers, but will they also help provide the follow up care and chemo that he needs to make a complete recovery, or will they vanish like the media now that the tumor is "out".
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