WILM’S TUMOR

Definition of Wilm’s tumor

Wilm’s tumor is a type of cancer that primarily affects children.
It originates in the kidneys and is a malignant tumor of the renal blastema.
Also known as nephroblastoma, it is a rare tumor but is the most common type of kidney cancer in children.

Pathology of Wilm’s tumor

Wilm’s tumor arises from the embryonic tissue of the kidney.
It is a malignant tumor composed of primitive epithelial cells, blastema cells, and mesenchymal cells.
The tumor cells are usually large and have a high nuclear-to-cytoplasmic ratio.
The tumor is characterized by the presence of abnormal mitotic figures and cellular pleomorphism.

Types of Wilm’s tumor

Triphasic pattern: Most common type, comprising of epithelial, blastema, and stromal components.
Monophasic epithelial pattern: Less common, comprising of epithelial cells only.
Monophasic blastemal pattern: Rare, comprising of blastema cells only.
Anaplastic type: Rare and aggressive, characterized by anaplastic cells.

Clinical manifestations and diagnostic findings

Common symptoms: Abdominal mass, abdominal pain, vomiting, and hypertension.
Diagnostic tests: Ultrasound, CT scan, and MRI are used for imaging, while histopathological examination is used for diagnosis.
Laboratory tests: Elevated levels of lactate dehydrogenase (LDH) and urine analysis may show hematuria.

Management of Wilm’s tumor

Surgery: Nephrectomy is the primary treatment, either radical or partial, depending on the tumor size and location.
Chemotherapy: Used as neoadjuvant or adjuvant therapy to reduce tumor size and eliminate any remaining cells.
Radiation therapy: May be used in cases with residual disease or metastasis.
Follow-up: Regular monitoring is required to detect any recurrence or metastasis.

Complications

Hematuria: Bleeding in the urine, which may be microscopic or macroscopic.
Hypertension: Elevated blood pressure, which may be due to renal artery compression or renal vein thrombosis.
Tumor recurrence: The tumor may recur after treatment, either locally or in distant sites.
Metastasis: The tumor may spread to other organs, such as the lungs, liver, or bone marrow.

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