Portal de Periódicos da CAPES

Bilateral Embryoma of the Kidney: Patient Alive and Well Three Years After Treatment

1956; Radiological Society of North America; Volume: 67; Issue: 1 Linguagem: Inglês

10.1148/67.1.99

1527-1315

Myron B. Close, Carrell A. Peterson, Richard P. Johnson,

Renal cell carcinoma treatment

Wilms' tumor, or embryoma of the kidney, is the most common malignant neoplasm of the abdomen in childhood. Several bilateral embryomas are reported in the literature, but to the best of our knowledge there has been only 1 such case with survival for an appreciable length of time. In that case, presented by Gross in 1953, the patient had survived for twelve years without sign of recurrence. A right nephrectomy had been performed and bilateral x-ray therapy administered. Microscopic proof of Wilms' tumor was, however, obtained only on the side of nephrectomy; biopsy of the tumor in the opposite kidney was not done. The case reported here was seen in January 1952, because of bilateral abdominal tumors, which were subsequently proved microscopically to be Wilms' tumors. The patient is now living and well three years after right nephrectomy, biopsy of the left kidney, and bilateral x-ray therapy. Case Report An 8-month-old white boy was admitted to the Children's Hospital of the East Bay (Oakland, Calif.) on Jan. 27, 1952, with bilateral upper abdominal masses and gross hematuria. The masses were discovered two weeks before admission on routine examination; hematuria was first observed two days prior to entry. There was no history of malaise, pain, weight loss, or arrest in development. At the age of two months, the patient exhibited stridor, and an upper respiratory infection occurred. Roentgenograms obtained at that time revealed an enlarged thymus, which was treated elsewhere by irradiation. Subsequent studies at this hospital showed a vascular ring about the trachea and esophagus, consisting of an anterior (left) and a larger posterior (right) aortic arch with a normal left descending aorta. Division of the anterior arch was performed to relieve pressure on the trachea. Recovery was satisfactory, and the child was considered well until the discovery of the abdominal tumors. The weight on admission was 21 pounds, and the temperature was 100° F. Physical examination revealed thickening and rubor of the tympanic membranes. The right flank was protuberant. A large, firm, non-movable, non-tender mass was present in the right upper quadrant, extending from beneath the costal margin almost to the umbilicus. The left kidney was twice its normal size and was also firm, non-movable, and non-tender. The liver and spleen were not palpable. Urinalysis showed a heavy concentration of red blood cells; the hemoglobin was 11.8 gm., the white blood count 4,000, and the differential cell count normal. Intravenous urograms demonstrated large bilateral homogeneous masses compatible with enlarged kidneys (Fig. 1). The collecting system was well visualized on either side, and no calcification, disturbance in drainage, or marked hydronephrosis was noted. On the left side, the calyces were seen in the upper portion of the mass. The calyces of the right kidney were inferiorly placed in the mass, with deformity due to external pressure.