WILMS TUMOR

Introduction
Wilms tumor is the most common childhood renal tumor,accounting for approximately 6 % off all pediatric malignancies

This tumor tends to occur between ages 1 and 3 years

The incidence of wilms tumor is 1 in 10000 children

HISTOLOGY
EMBRIONAL RENAL NEOPLASMA
BLASTEMAL

STROMAL

EPITHELIAL CELLS

NEPHROGENIC REST

Nephrogenic rest is defined as the persisitance of metanephric tissue in the kidney after 36th of gestation This lession precursor of wilms tumor

CYTOGENETIC

Wilms tumor suppressor gene chromosome 11p15

CLINICAL PRESENTATION
Asymptoma tic adominal mass

Gross or microscopic hematuria

Hypertensio n

Cardiac murmur,hepatosplenome galy,asites,varicoco;e,goa n metastasi

Fever ,malaise,an emia

Diagnosis

Chest radiography detect pulmonary metastatis Abdominal radiography linear calcification Ultrasound consistency of the mass,intravascular involment Ct scan of abdomen renal mass, anatomic extent of tumor,the precense of a normalcontralateral kidney and possibility of bialteral tumor involment

staging

Stage 1

Tumor confined to the kidney and completely resected; no penetration of the renal capsule or involvement of renal sinus vessels

Stage 2 Stage 3

Tumor extend beyond the kidney but is completely resected 9 negative margins and lymph nodes; at least of the following has occured : Penetration of the renal capsule,invasion of the renal sinus vessels,biopsy of tumor perfomed before removal,spillage of tumor lacally during removal

Gross of microscopic residual tumor remains postoperativvely,inducing inoperable tumor,positive surgical margins, tumor sillage invo;ving peritoneal surfaces,regional lymph node metastases or transected tumor trombus

 Hematogenous or lymph node metastases outside the abdomen ( lung,liver,bone,brain)

Bilateral renal wilms tumor

Treatment
Full exploration
Surgical

intravascular extension

Dactinomycin Vincristine doxorubbicin chemotherapy Combination of cyclophospamid,ifosfamide,carboplatin,etoposide

Radiotion therapy

Local abdominal irradition for stage III favorable histology tumor and for stage II,III with diffuse anaplatic wilms tumor

Considered for wilms tumor that are not completely resectable at initial operation. Benefit in children whoolment,extensive have Preope bilateral inv intravascular involment,inoperable therapyerativ massiv tumor