Robotic approach with neoadjuvant chemotherapy in adult Wilms' tumor: A feasibility study report and a systematic review of the literature

Hope and challenges in the diagnosis and treatment of Wilms tumor: a single-center retrospective study in China

Background

Wilms tumor (WT), which represents about 90% of kidney tumors in children, is the most prevalent type of renal tumor among children. In developed countries, advancements in treatments such as chemotherapy and radiotherapy have led to high survival rates. However, developing countries face significant challenges, including late-stage diagnosis, metastasis at presentation, and high rates of treatment abandonment.

Methods

This retrospective study included all patients diagnosed with WT at a tertiary hospital in Western China from 2007 to 2021. It involved the collection of sociodemographic and clinical details, including data on patients who abandoned treatment. Follow-up continued until July 2024.

Results

This study consisted of 301 WT patients. Of the 259 who completed the treatment, the 5-year event-free survival (EFS) and overall survival (OS) rates were 77.9% and 81.2%. Of the 42 patients who abandoned treatment, 13 refused further care immediately after diagnosis and signed a refusal document, 16 discontinued treatments during preoperative neoadjuvant chemotherapy, and 13 failed to complete the prescribed chemotherapy or radiotherapy.

Conclusion

Survival rates for WT patients at our institution approach those reported in developed countries. Challenges include late-stage diagnosis, metastasis at initial presentation, and treatment abandonment. To address these issues, implementing pediatric screening is critical for early detection and timely intervention, particularly for families vulnerable to abandoning treatment. For high-risk cases, oncologists need develop targeted strategies to enhance clinical outcomes.

Clinical value of ultrasound in adult Wilms' tumor patient with uremia: A case report and literature review

RATIONALE

Wilms' tumor (WT) is the most common pediatric kidney malignancy and is rarely found in adults. Nonspecific clinical symptoms and imaging features often lead to delayed diagnosis or misdiagnosis of adult WT, resulting in poor clinical outcomes. Ultrasound (US), as an efficient and noninvasive examination method, has been widely used in clinical diagnosis and treatment. Therefore, various US evidence is meaningful to improve understanding of adult WT characteristics in ultrasound.

PATIENT CONCERNS

A 45-year-old female patient with uremia (regular hemodialysis for 13 years) with painless gross hematuria was diagnosed with a right kidney tumor penetrating to the lung. Preoperatively, B-mode ultrasonography showed an ill-defined hyperechoic mass in the right kidney, which revealed an unclear border, uneven internal echoes, and calcification. Besides, the internal blood flow signal of the tumor was detected. Contrast-enhanced ultrasound (CEUS) showed an uneven hyper-enhancement in the tumor ("fast in and slow out"). Contrast-enhanced computed tomography of the kidney indicated a similar result as the CEUS. Moreover, the chest CT identified multiple pulmonary metastatic nodules.

DIAGNOSES

An ultrasound-guided percutaneous core needle biopsy of the tumor proceeded to make a definite diagnosis of adult WT (epithelial type).

INTERVENTIONS

The patient was treated with tislelizumab.

OUTCOMES

No progress was found to date.

LESSONS

We report the first case in which CEUS was performed in an adult WT patient with uremia and multiple pulmonary metastases. The features obtained by the US can help in the diagnosis of adult WT and direct further diagnostic procedures.

Breaking down tumor thrombus: Current strategies for medical management

Tumor thrombus, the intravascular extension of tumor into adjacent blood vessels, is frequently encountered in patients with renal cell carcinoma and hepatocellular carcinoma, and often involves the abdominal vasculature including the renal vein, portal vein, and the inferior vena cava. While a bland thrombus is composed of platelets and fibrin, in contrast, a tumor thrombus refers to an organized collection of tumor cells. Though oftentimes detected incidentally on imaging, tumor thrombus may have significant clinical implications and can be challenging to differentiate from bland thrombus. Additionally, the optimal management of tumor thrombus, including the use of anticoagulation, remains poorly described. This review summarizes common causes of tumor thrombus, as well as its impact on staging, prognosis, and treatment.