[Dumbbell nephroblastoma: an uncommon cause of spinal cord compression]

A Wilms' Tumor with Spinal Cord Compression: An Extrarenal Origin?

Spinal cord compression in Wilms' tumor (WT) is an extremely rare event that can have a very poor prognosis if not taken care of rapidly. Most cases reported in the literature involve widely metastatic patient with bone or paraspinal metastases or occasionally intradural metastasis. Here, we present the case of a 3-year-old girl of WT confirmed by biopsy, with spinal cord compression due to the direct contiguous spread of a tumor through 2 vertebral foramina. Abdominal ultrasonography and magnetic resonance imaging performed for an abdominal mass revealed a large heterogeneous tumor near the upper pole of the left kidney. A nodular infiltration extended through the T11-L1 and L1-L2 neural foramina, forming an intraspinal mass that compressed the spinal cord. Major paresthesia subsequently occurred, requiring urgent treatment with corticosteroids and chemotherapy. The evolution was rapidly satisfying. After six courses of chemotherapy, a left nephrectomy was performed. Macroscopic examination identified a large tumor attached to the kidney without renal infiltration. Microscopical examination concluded to a nephroblastoma with regressive changes, of intermediate risk. Evolution at 6 months is satisfactory, with no neurological deficit. The histological aspect of the tumor and the clinical outcome suggest that she had an extrarenal WT that spread through the vertebral foramina and was secondarily attached to the kidney.

Bone Vertebrae Metastases With Spinal Cord Compression: A Rare Event in Wilms Tumor

Bone metastases and intraspinal spread are rare events in Wilms tumor. We report 2 cases of Wilms tumor with vertebral metastases associated with spinal cord compression; 1 case was reported during diagnosis and the other at relapse. Both children benefited from emergency surgical decompression followed by intensive multimodality therapy, resulting in long-term disease-free remission.

Spinal cord compression and lung metastasis of Wilms' tumor in a pregnant adolescent

Wilms' tumor in adults is rare, and no treatment guidelines have been established. Spinal cord compression has also been rarely reported in all age groups. In this case report, we present a 19-year-old adolescent with recurrent Wilms' tumor, a paraspinal dumbbell mass, metastatic involvement of the vertebral bodies, lung metastasis, and pregnancy. To our knowledge, this is the first report of a pregnant patient with Wilms' tumor who had to undergo immediate chemotherapy with vincristine and actinomycin-D owing to spinal cord compression at 25 weeks of pregnancy. After delivery, complete remission was maintained with a regimen of ifosfamide, carboplatin, and etoposide and vincristine, actinomycin-D, and cyclophosphamide. No teratogenic or other toxic effects of vincristine or actinomycin-D were observed in the fetus.