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Sepenu P, Swarray-Deen A, Scott A, Boafor TK, Baah WK, Kyei MK, Coleman J. Disseminated adult Wilms tumor in pregnancy: Leveraging multidisciplinary care in a low-resource setting. Int J Gynaecol Obstet 2024; 165:601-606. [PMID: 37731328 DOI: 10.1002/ijgo.15157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/27/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023]
Abstract
Wilms tumor (WT) occurring in adults is rare and even much more rarely found to coexist with pregnancy. Clinical outcome in adults is worse overall compared with pediatric patients with WT and is often misdiagnosed with no standardized protocols for care guided by high-evidence clinical trials. We present a case of a 23-year-old woman diagnosed with WT who was found to be pregnant immediately following nephrectomy. Workup findings showed that she had disseminated disease but was successfully managed in a multidisciplinary team setting with modified intrapartum chemotherapy followed by postpartum chemotherapy. In low-resource settings, management protocols for adult patients with WT can be individualized by multidisciplinary teams to leverage available resources for best outcomes.
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Affiliation(s)
- Perez Sepenu
- Department of Obstetrics & Gynecology, Maternal-Fetal Medicine Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Alim Swarray-Deen
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Aba Scott
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Theodore K Boafor
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
| | - Winfred K Baah
- Department of Medicine & Therapeutics, University of Ghana Medical School, Accra, Ghana
| | - Mathew K Kyei
- Department of Surgery, Urology Unit, University of Ghana Medical School, Accra, Ghana
| | - Jerry Coleman
- Department of Obstetrics & Gynecology, University of Ghana Medical School, Accra, Ghana
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Sforza S, Palmieri VE, Raspollini MR, Roviello G, Mantovani A, Basso U, Affinita MC, D'Angelo A, Antonuzzo L, Carini M, Minervini A, Masieri L. Robotic approach with neoadjuvant chemotherapy in adult Wilms' tumor: A feasibility study report and a systematic review of the literature. Asian J Urol 2023; 10:128-136. [PMID: 36942112 PMCID: PMC10023547 DOI: 10.1016/j.ajur.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 06/04/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022] Open
Abstract
Objective The incidence of Wilms' tumor (WT) among adult individuals accounts for less than 1% of kidney cancer cases, with a prognosis usually less favorable when compared to younger individuals and an overall survival rate of 70% for the adult patients versus 90% for the pediatric cases. The diagnosis and treatment of WT are complex in the preoperative setting; neoadjuvant chemotherapy (NAC) or robotic surgery has rarely been described. This study aimed to review the literature of robotic surgery in WT and report the first adult WT management using both NAC and robotic strategy. Methods We reported a case of WT managed in a multidisciplinary setting. Furthermore, according to Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations, a systematic review of the literature until August 2020 of WT treated with a robotic approach was carried out. Results A 33-year-old female had a diagnosis of WT. She was scheduled to NAC, and according to the clinical and radiological response to a robotic radical nephrectomy with aortic lymph nodes dissection, she was managed with no intraoperative rupture, a favorable surgical outcome, and a follow-up of 25 months, which did not show any recurrence. The systematic review identified a total number of 230 cases of minimally invasive surgery reported in the literature for WT. Of these, approximately 15 patients were carried out using robotic surgery in adolescents while none in adults. Moreover, NAC has not been administered before minimally invasive surgery in adults up until now. Conclusion WT is a rare condition in adults with only a few cases treated with either NAC or minimally invasive approach so far. The advantage of NAC followed by the robotic approach could lead to favorable outcomes in this complex scenario. Notwithstanding, additional cases of adult WT need to be identified and investigated to improve the oncological outcome.
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Affiliation(s)
- Simone Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
- Corresponding author. Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.
| | | | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Careggi Hospital, University of Florence, Florence, Italy
| | | | - Alberto Mantovani
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - Umberto Basso
- Medical Oncology Unit 1, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | - Maria Carmen Affinita
- Hematology Oncology Division, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy
| | - Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath, Bath, UK
| | - Lorenzo Antonuzzo
- Clinical Oncologic Unit, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
- Department of Pediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
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Bai YF, Niu JQ, Shangguan JY, Liang JJ, Wu XH, Wang W, Ren XQ, An RF, Liu JZ. Asymptomatic adult Wilms' tumor: A case report. Radiol Case Rep 2022; 17:2802-2805. [PMID: 35694636 PMCID: PMC9184870 DOI: 10.1016/j.radcr.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/20/2022] [Indexed: 11/01/2022] Open
Abstract
Wilms' tumor, also called nephroblastoma, is an extremely uncommon kidney tumor of adulthood. We reported a adult man with a left kidney mass diagnosed as Wilms' tumor. Case presentation: A 25-year-old man was hospitalized due to injury of the anterior cruciate ligament of the right knee. Preoperative imaging accidentally revealed a mass measuring 53 × 46 mm involving the middle and lower segments of the left kidney without evidence supporting the invasion of the surrounding structures or metastasis. The patient didn't show any symptom commonly occurred in Wilms' tumor, such as flank pain or hematuria. After nephrectomy, the diagnosis of adult Wilms' tumor was confirmed based on the tumor morphology and immunohistochemical findings. Conclusion: In adult patients without any clinical manifestations or favorable imaging findings for low-stage renal cell carcinoma, the diagnosis of Wilms' tumor should be taken into consideration.
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Sudour-Bonnange H, Coulomb-Lherminé A, Fantoni JC, Escande A, Brisse HJ, Thebaud E, Verschuur A. Standard of care for adult Wilms tumor? From adult urologist to pediatric oncologist. A retrospective review. Bull Cancer 2020; 108:177-186. [PMID: 33129487 DOI: 10.1016/j.bulcan.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Nephroblastoma or Wilms tumor, a common embryonal tumor in children, can occasionally occur in adults. The survival of patients older than 18 years is reported to be significantly inferior to that of pediatric patients. Establishing a diagnosis for these rare tumors can be challenging for both clinicians and pathologists, who are not accustomed to considering Wilms tumor as a potential differential in adults. This leads to misdiagnosis and a subsequent delay in the initiation of appropriate therapy. The standard of care is not well established for Wilms tumors in adults. We provide here a comprehensive review of the international literature on the subject with the current management protocols in France. We also propose the need of strong inter-disciplinary collaboration between surgeons, pathologists, and medical and pediatric oncologists for increasing knowledge and formulating treatment strategies for these rare tumors. Homogenous guidelines for treating adults with Wilms tumors have been proposed for all patients in France.
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Affiliation(s)
| | | | | | | | | | - Estelle Thebaud
- CHRU Nantes, department of pediatric hemato-oncology, Nantes, France
| | - Arnaud Verschuur
- AP-HM, La Timone Children's hospital, department of pediatric oncology and hematology, Marseille, France
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