Intussusception following resection of Wilms tumor

Wilms' tumor--lessons and outcomes--a 25-year single center UK experience

Wilms' tumor (WT) is a common childhood renal cancer. A 25-year single center UK experience is reported. During 1985-2010, 97 children underwent immediate nephrectomy or delayed resection of tumor after chemotherapy. Survival, morbidity, and late effects following treatment are described. Tumor distribution was: Stage I, 25.7% (n = 25); Stage II, 24.7% (n = 24); Stage III, 26.8% (n = 26); Stage IV, 17.5% (n = 17); and Stage V, 5.2% (n = 5). Immediate nephrectomy was performed in 39% (n = 38) patients with elective delayed resection in 61% (n = 59) cases. Ten patients had cavotomy to excise tumor involving vena cava territory. Two cases required cardiopulmonary bypass. Tumor rupture was recorded in eight (8.5%) total operated cases-after immediate (n = 5/37), 13.5% vs delayed nephrectomy-(n = 3/57), 5.2%; X(2) P = .154. From 2001 onwards, one case of tumor rupture was recorded at this center after the universal adoption of UKW3 and SIOP guidelines advocating preoperative chemotherapy and delayed nephrectomy for all WT. Three treatment-related deaths occurred-hepatic veno-occlusive disease (n = 2) with actinomycin D and a single WT fatality due to vascular injury. Overall survival was 84.5% (82/97 cases). Two patients developed "late malignancies" -thyroid cancer and a basal cell carcinoma. This study demonstrates excellent survival for WT comparable with national outcomes and international cooperative studies. Adverse events with chemotherapy and surgery, including "late onset," second malignancies deserve special consideration.

Postoperative small-bowel intussusception in children with cancer

The clinical and imaging features of small-bowel intussusception as a complication of abdominal surgery are not well known. Diagnosis may be delayed because symptoms mimic common postoperative complaints. In pediatric cancer patients, the side effects of chemotherapy and symptoms related to the primary malignancy may also obscure the diagnosis. We report the clinical and radiographic features of eight children undergoing evaluation and treatment for solid tumors who developed small-bowel intussusception following laparotomy. These children represent 2.2% of all children and adolescents who underwent laparotomy at a pediatric cancer research and treatment center during a 13-year period. With prompt diagnosis and intervention, morbidity and mortality from this rare but life-threatening postoperative complication can be avoided.

Aggressive inflammatory pseudotumor of the abdomen 9 years after therapy for Wilms tumor. A complication, coincidence, or association?

BACKGROUND

Inflammatory pseudotumor (IPT) is a benign lesion that occurs in various organs and tissues. It is usually sharply demarcated from the surrounding tissue and surgery is considered to be the best treatment.

METHODS

This article discusses a 15-year-old boy with an aggressive IPT of the abdomen occurring 9 years after therapy for Wilms tumor.

RESULTS

IPT widely involved the esophagus, stomach, and liver, producing severe dysphagia. Histologically, it showed classic features of IPT and, also, areas of metaplastic bone, a new feature recently described in the same lesion of the kidney. It mimicked malignant tumor clinically and led to extensive surgery, but early follow-up has shown no recurrence.

CONCLUSION

Although many complications of surgery and chemotherapy are well known, the authors believe that it is unlikely to be the cause of IPT in the case presented. Therefore, the possibility of coincidence or association of Wilms tumor and IPT remains open.

Postoperative intussusception in children

Intussusception in the postoperative period is an unusual yet potentially fatal surgical complication. We present 3 illustrative cases and contrast postoperative intussusception with the more common classic childhood intussusception. Physician awareness of this condition is critical for early recognition and treatment.