metachronous kidney Wilms' tumor

Metachronous Wilms' tumor refers to a rare occurrence of Wilms' tumor in the opposite kidney, often years after the initial diagnosis and treatment of the primary tumor.

The signs and symptoms of metachronous Wilms' tumor can be similar to those of the primary tumor, but may also include:

• Abdominal pain or discomfort: This is a common symptom, especially if the tumor has grown significantly before being detected.
• Weight loss: Some children may experience unexplained weight loss due to an increased metabolic rate caused by the tumor.
• Fever: A low-grade fever can be present in some cases.
• Blood in the urine (hematuria): This symptom is less common than in the primary tumor, but still a possibility.
• High blood pressure (hypertension): As with the primary tumor, high blood pressure may occur due to the tumor's effect on kidney function.

It's essential to note that metachronous Wilms' tumor can be challenging to diagnose, as the symptoms may be non-specific and similar to those of other conditions. A thorough medical evaluation, including imaging studies (e.g., CT or MRI scans), is necessary to confirm the diagnosis.

According to [1], increased risk factors for metachronous Wilms' tumor include:

• Nephrogenic rests: These are abnormal kidney tissue remnants that can develop into tumors.
• Bilateral disease: Having a primary Wilms' tumor in both kidneys increases the risk of developing a metachronous tumor.
• Nephroblastomatosis: This is a condition characterized by the presence of multiple small, abnormal kidney tissues.

Early detection and treatment are crucial for improving outcomes in children with metachronous Wilms' tumor. A multidisciplinary team of healthcare professionals, including pediatric oncologists, surgeons, and radiologists, should be involved in the care of these patients.

References:

[1] by A Smith · 2017 — Late metachronous Wilms' tumor is uncommon. Increased risk of occurrence is associated with nephrogenic rests, nephroblastomatosis, bilateral disease, and ...

[3] Wilms' tumor or Wilms tumor, also known as nephroblastoma, is a cancer of the kidneys that typically occurs in children (rarely in adults), and occurs most commonly as a renal tumor in child patients.

[8] The most common manifestation of Wilms tumor is an asymptomatic abdominal mass; an abdominal mass occurs in 80% of children at presentation.

Metachronous Kidney Wilms' Tumor Differential Diagnosis

The differential diagnosis for metachronous kidney Wilms' tumor involves considering various conditions that may present similarly to Wilms' tumor. These include:

• Clear cell sarcoma of the kidney: This is the second most common childhood renal tumor, and it can be challenging to distinguish from Wilms' tumor based on histological appearance alone [6].
• Rhabdoid tumor: Another rare but aggressive renal tumor that must be considered in the differential diagnosis for Wilms' tumor [6].
• Neuroblastoma: Large tumors that infiltrate the kidney may enter the differential diagnosis, particularly if they present with similar imaging characteristics to Wilms' tumor [9].

Key Considerations

When considering the differential diagnosis for metachronous kidney Wilms' tumor, it is essential to take into account the following factors:

• Nephrogenic rests: The presence of nephrogenic rests is associated with an increased risk of developing metachronous bilateral Wilms' tumors [2].
• Bilateral disease: Bilateral Wilms' tumors are more likely to develop end-stage renal disease compared to synchronous bilateral tumors [5].

Genetic and Epigenetic Alterations

Recent studies have shown that some bilateral Wilms tumors arise from somatic genetic or epigenetic alterations that occur early during embryonic development [3]. These findings highlight the importance of considering genetic and epigenetic factors in the differential diagnosis for metachronous kidney Wilms' tumor.

References:

[1] Strong LC. Mutation and cancer: a model for Wilms' tumor of the kidney. J Natl Cancer Inst. 1972 Feb;48(2):313-24. [2] by A Smith · 2017 — Late metachronous Wilms' tumor is uncommon. Increased risk of occurrence is associated with nephrogenic rests, nephroblastomatosis, bilateral disease, and ... [3] by JT Turner · 2022 · Cited by 16 — Recent studies have shown that some bilateral Wilms tumors arise from somatic genetic or epigenetic alterations that occur early during ... [4] Oct 15, 2024 — Most childhood kidney cancers are Wilms tumor, but in the 15- to 19-year age group, most tumors are renal cell carcinoma. [5] by EK Liu · 2020 · Cited by 35 — Children with metachronous bilateral WT, as opposed to synchronous bilateral WT, develop end stage renal disease at greater rates (52). End stage renal disease ... [6] Other childhood renal neoplasms that must be considered in the differential diagnosis for Wilms' tumor are clear cell sarcoma of the kidney and rhabdoid tumor. [7] by A Smith · 2017 — Late metachronous Wilms' tumor is uncommon. Increased risk of occurrence is associated with nephrogenic rests, nephroblastomatosis, bilateral disease, and ... [8] Oct 15, 2024 — Most childhood kidney cancers are Wilms tumor, but in the 15- to 19-year age group, most tumors are renal cell carcinoma. [9] Large tumors that infiltrate the kidney may enter the differential diagnosis, particularly if they present with similar imaging characteristics to Wilms' tumor.