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Howell J, Maughan B, Fluchel M, Poppe M. Pediatric regimens in the treatment of adult-onset, metastatic Wilms tumor: A case report. Urol Case Rep 2024; 56:102799. [PMID: 39119470 PMCID: PMC11305201 DOI: 10.1016/j.eucr.2024.102799] [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: 06/11/2024] [Accepted: 07/14/2024] [Indexed: 08/10/2024] Open
Abstract
The optimal treatment of adult-onset Wilms tumors (WTs) in elderly patients is a debated area, as pediatric protocols are thought to carry unacceptable toxicity. We treated a 62-year-old female with good performance status and Stage IV (T1b N1 M1) favorable histology WT using pediatric adjuvant and salvage chemoradiation protocols. Though she experienced nodal relapse and both adjuvant and salvage treatment were discontinued early due to toxicity, she obtained excellent oncologic outcomes, having remained disease-free for 32 months. We recommend considering pediatric protocols for elderly WT patients with good performance status, anticipating dose reductions and possible early chemotherapy termination.
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Affiliation(s)
- Jackson Howell
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Benjamin Maughan
- Division of Medical Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Mark Fluchel
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew Poppe
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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Chan GJ, Stohr BA, Osunkoya AO, Croom NA, Cho SJ, Balassanian R, Charu V, Bean GR, Chan E. Wilms Tumor: An Unexpected Diagnosis in Adult Patients. Arch Pathol Lab Med 2024; 148:722-727. [PMID: 37756569 DOI: 10.5858/arpa.2023-0127-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 09/29/2023]
Abstract
CONTEXT.— Wilms tumor (WT) in adult patients is rare and has historically been a diagnostic and therapeutic conundrum, with limited data available in the literature. OBJECTIVE.— To provide detailed diagnostic features, molecular profiling, and patient outcomes in a multi-institutional cohort of adult WT patients. DESIGN.— We identified and retrospectively examined 4 adult WT cases. RESULTS.— Two patients presented with metastatic disease, and diagnoses were made on fine-needle aspiration of their renal masses. The aspirates included malignant primitive-appearing epithelioid cells forming tubular rosettes and necrosis, and cell blocks demonstrated triphasic histology. In the remaining 2 cases, patients presented with localized disease and received a diagnosis on resection, with both patients demonstrating an epithelial-predominant morphology. Tumor cells in all cases were patchy variable positive for PAX8 and WT1 immunohistochemistry. Next-generation sequencing identified alterations previously reported in pediatric WT in 3 of 4 cases, including mutations in ASXL1 (2 of 4), WT1 (1 of 4), and the TERT promoter (1 of 4), as well as 1q gains (1 of 4); 1 case showed no alterations. Three patients were treated with pediatric chemotherapy protocols; during follow-up (range, 26-60 months), 1 patient died of disease. CONCLUSIONS.— WT is an unexpected and difficult entity to diagnose in adults and should be considered when faced with a primitive-appearing renal or metastatic tumor. Molecular testing may help exclude other possibilities but may not be sensitive or specific because of the relatively large number of driver mutations reported in WT.
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Affiliation(s)
- Garrett J Chan
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Bradley A Stohr
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Adeboye O Osunkoya
- the Departments of Pathology and Urology, Emory University School of Medicine, Atlanta, Georgia (Osunkoya)
| | - Nicole A Croom
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Soo-Jin Cho
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Ronald Balassanian
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
| | - Vivek Charu
- the Department of Pathology, Stanford University School of Medicine, Stanford, California (Charu, Bean)
| | - Gregory R Bean
- the Department of Pathology, Stanford University School of Medicine, Stanford, California (Charu, Bean)
| | - Emily Chan
- From the Department of Pathology, University of California, San Francisco (G.J. Chan, Stohr, Croom, Cho, Balassanian, E. Chan)
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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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Schmeusser BN, Palacios AR, Midenberg E, Nabavizadeh R, Master VA, Joshi SS. Case report: Important considerations for a renal mass on a solitary kidney in an adult with history of childhood wilms tumor. Front Oncol 2022; 12:971341. [PMID: 35992837 PMCID: PMC9382288 DOI: 10.3389/fonc.2022.971341] [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: 06/16/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Adult survivors of childhood Wilms tumor are at an increased risk of secondary malignant neoplasms. The presence of a solitary kidney further complicates clinical management in this population. Herein, we present the case of a 37 year old female with a history of childhood Wilms tumor presenting with a secondary renal neoplasm. We highlight important clinical considerations for renal function preservation and present a finding of predisposition to kidney stone formation due to urinary stasis from distorted ureter architecture secondary to tumor mass effect.
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