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Qu YN, Wu YR, Qu D, Ge HY. Extrarenal Wilms tumor with hypertension and dilated cardiomyopathy in an infant: A report of an unusual case. Pediatr Blood Cancer 2022; 69:e29900. [PMID: 35920589 DOI: 10.1002/pbc.29900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/28/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022]
Abstract
While Wilms tumors are the most frequently detected kidney cancer type in children, extrarenal Wilms tumors (ERWTs) remain rare. This report is the first to describe hypertension and dilated cardiomyopathy in a patient with an ERWT. A 6-month-old male infant presented with an abdominal mass and paroxysmal hypertension; echocardiography revealed dilated cardiomyopathy with an ejection fraction of 34%, as well as substantially increased plasma renin activity. Pathology yielded a definitive diagnosis of ERWT. Cardiac function and blood pressure gradually returned to normal after tumorectomy. The early diagnosis of such a tumor together with efficient oncologic treatment are vital to optimal patient outcomes.
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Affiliation(s)
- Yan-Ning Qu
- Department of Intensive Care Unit, Capital Institute of Pediatric Children's Hospital, Beijing, China
| | - Yu-Rui Wu
- Department of Thoracic and Oncological Surgery, Capital Institute of Pediatric Children's Hospital, Beijing, China
| | - Dong Qu
- Department of Intensive Care Unit, Capital Institute of Pediatric Children's Hospital, Beijing, China
| | - Hai-Yan Ge
- Department of Intensive Care Unit, Capital Institute of Pediatric Children's Hospital, Beijing, China
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2
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Steur A, Raymakers-Janssen PAMA, Kneyber MCJ, Dijkstra S, van Woensel JBM, van Waardenburg DA, van de Ven CP, van der Steeg AFW, Wijnen M, Lilien MR, de Krijger RR, van Tinteren H, Littooij AS, Janssens GO, Peek AML, Tytgat GAM, Mavinkurve-Groothuis AM, van Grotel M, van den Heuvel-Eibrink MM, Asperen RMWV. Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy. Cancers (Basel) 2022; 14:943. [PMID: 35205701 PMCID: PMC8870004 DOI: 10.3390/cancers14040943] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Survival rates are excellent for children with Wilms tumor (WT), yet tumor and treatment-related complications may require pediatric intensive care unit (PICU) admission. We assessed the frequency, clinical characteristics, and outcome of children with WT requiring PICU admissions in a multicenter, retrospective study in the Netherlands. Admission reasons of unplanned PICU admissions were described in relation to treatment phase. Unplanned PICU admissions were compared to a control group of no or planned PICU admissions, with regard to patient characteristics and short and long term outcomes. In a multicenter cohort of 175 children with an underlying WT, 50 unplanned PICU admissions were registered in 33 patients. Reasons for admission were diverse and varied per treatment phase. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were observed in children with unplanned PICU admission versus the other WT patients. Three children required renal replacement therapy, two of which continued dialysis after PICU discharge (both with bilateral disease). Two children died during their PICU stay. During follow-up, hypertension and chronic kidney disease (18.2 vs. 4.2% and 15.2 vs. 0.7%) were more frequently observed in unplanned PICU admitted patients compared to the other patients. No significant differences in cardiac morbidity, relapse, or progression were observed. Almost 20% of children with WT required unplanned PICU admission, with young age and treatment intensity as potential risk factors. Hypertension and renal impairment were frequently observed in these patients, warranting special attention at presentation and during treatment and follow-up.
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Affiliation(s)
- Anouk Steur
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Paulien A. M. A. Raymakers-Janssen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
| | - Martin C. J. Kneyber
- Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital/University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.C.J.K.); (S.D.)
| | - Sandra Dijkstra
- Division of Pediatric Critical Care Medicine, Beatrix Children’s Hospital/University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (M.C.J.K.); (S.D.)
| | - Job B. M. van Woensel
- Department of Pediatric Intensive Care, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands;
| | - Dick A. van Waardenburg
- Department of Pediatric Intensive Care, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands;
| | - Cornelis P. van de Ven
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Alida F. W. van der Steeg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marc Wijnen
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marc R. Lilien
- Department of Pediatric Nephrology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annemieke S. Littooij
- Department of Radiology, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands;
| | - Geert O. Janssens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annemarie M. L. Peek
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Godelieve A. M. Tytgat
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Annelies M. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Martine van Grotel
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (A.S.); (P.A.M.A.R.-J.); (C.P.v.d.V.); (A.F.W.v.d.S.); (M.W.); (R.R.d.K.); (H.v.T.); (G.O.J.); (A.M.L.P.); (G.A.M.T.); (A.M.M.-G.); (M.v.G.); (M.M.v.d.H.-E.)
| | - Roelie M. Wösten-van Asperen
- Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital/University Medical Center Utrecht, 3584 EA Utrecht, The Netherlands
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Congestive heart failure and hypertension associated with Wilms tumor. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kilcoyne M, Mohan V, Stevens R, Mahan V. Metastatic Wilms tumor and dilated cardiomyopathy. Ann Pediatr Cardiol 2021; 14:564-565. [PMID: 35527769 PMCID: PMC9075551 DOI: 10.4103/apc.apc_272_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/03/2021] [Accepted: 05/19/2021] [Indexed: 11/04/2022] Open
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Sosnowska-Sienkiewicz P, Gowin E, Jończyk-Potoczna K, Mańkowski P, Godziński J, Januszkiewicz-Lewandowska D. Bilateral Nephroblastoma with Dilated Cardiomyopathy as an Indication for Off-Protocol Treatment: A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249483. [PMID: 33352828 PMCID: PMC7766981 DOI: 10.3390/ijerph17249483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 11/18/2022]
Abstract
Patients with a Wilms tumor are often admitted to the hospital accidentally, with an abdominal mass causing asymmetry of the abdominal wall. Hypertension accompanying a Wilms tumor occurs in about 10–27% of children, but cardiomyopathy associated with a Wilms tumor is very rarely described. This publication presents a case of a 9-month-old girl with a bilateral Wilms tumor accompanied by dilated cardiomyopathy since her initial cancer diagnosis, as well as her off-protocol treatment. The severe condition of the child forced the application of off-protocol treatment, i.e., accelerated resection of a larger tumor, which enabled the improvement of heart performance and made subsequent therapy possible. In the course of the presented treatment, a gradual normalization of cardiac ventricular function and contractility was observed. In conclusion, a massive abdominal tumor associated with abdominal compartment syndrome compromised the functioning of the cardiovascular system in the young child. Therefore, earlier removal of Wilms tumors in patients with heart failure should be considered. This may result in the improvement of cardiovascular function and the possibility of further therapy.
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Affiliation(s)
- Patrycja Sosnowska-Sienkiewicz
- Department of Pediatric Surgery, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
- Correspondence: ; Tel.: +48-61-8491-578; Fax: +48-61-8491-228
| | - Ewelina Gowin
- Department of Health Promotion, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
| | | | - Przemysław Mańkowski
- Department of Pediatric Surgery, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
| | - Jan Godziński
- Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, 50-041 Wroclaw, Poland;
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Chung JM, Lee SD. Wilms Tumor with dilated hypertensive cardiomyopathy, acute myocarditis, pulmonary edema, and heart failure. Urol Case Rep 2020; 33:101391. [PMID: 33102089 PMCID: PMC7574032 DOI: 10.1016/j.eucr.2020.101391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/16/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
An 11-month-old boy with unilateral Wilms tumor had an unusual presentation, with dilated hypertensive cardiomyopathy, acute myocarditis, pulmonary edema, and congestive heart failure secondary to the Wilms tumor and requiring intensive care. After surgery, all of the findings were normalized. According to the literature review there were reported previously in only seven cases with dilated cardiomyopathy. Wilms tumor should be included in the differential diagnosis of any child with dilated cardiomyopathy and an abdominal mass, regardless of the presence of hypertension, especially less than one year old. Also, vasoactive mediators including renin should be evaluated in the case of hypertension.
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Affiliation(s)
- Jae Min Chung
- Department of Urology, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Corresponding author. Department of Urology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan, 626-700, South Korea.
| | - Sang Don Lee
- Department of Urology, Pusan National University School of Medicine, Yangsan, South Korea
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, South Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Sethasathien S, Choed-Amphai C, Saengsin K, Sathitsamitphong L, Charoenkwan P, Tepmalai K, Silvilairat S. Wilms tumor with dilated cardiomyopathy: A case report. World J Clin Oncol 2019; 10:293-299. [PMID: 31528545 PMCID: PMC6717704 DOI: 10.5306/wjco.v10.i8.293] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Wilms tumor is the most common renal malignancy in childhood. It occurs primarily between the ages of 2 and 5 years. The usual manifestations are abdominal mass, hypertension, and hematuria. The case presented here had an unusual presentation, with dilated cardiomyopathy and hypertension secondary to the Wilms tumor.
CASE SUMMARY A 3-year-old boy presented with a 5-d history of irritability, poor appetite, and respiratory distress. His presenting clinical symptoms were dyspnea, tachycardia, hypertension, and a palpable abdominal mass at the left upper quadrant. His troponin T and pro-B-type natriuretic peptide levels were elevated. Echocardiography demonstrated a dilated hypokinetic left ventricle with an ejection fraction of 29%, and a suspected left renal mass. Computed tomography scan revealed a left renal mass and multiple lung nodules. The definitive diagnosis of Wilms tumor was confirmed histologically. The patient was administered neoadjuvant chemotherapy and underwent radical nephrectomy. After surgery, radiotherapy was administered, and the adjuvant chemotherapy was continued. The blood pressure and left ventricular function normalized after the treatments.
CONCLUSION Abdominal mass, dilated cardiomyopathy and hypertension can indicate Wilms tumor in pediatric patients. Chemotherapy and tumor removal achieve successful treatment.
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Affiliation(s)
- Saviga Sethasathien
- Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Chane Choed-Amphai
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kwannapas Saengsin
- Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Lalita Sathitsamitphong
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Pimlak Charoenkwan
- Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Kanokkan Tepmalai
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Suchaya Silvilairat
- Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Ganigara A, Ramavakoda CY, Srinivasan CM, Ganigara M. Dilated cardiomyopathy in a child with abdominal neuroblastoma and normal serum catecholamine levels: anaesthetic management and review of literature. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2017. [DOI: 10.1080/22201181.2017.1283742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anuradha Ganigara
- Department of Pediatric Anesthesiology, Indira Gandhi Institute of Child Health, Bangalore, India
| | | | - Chandana M Srinivasan
- Department of Pediatric Anesthesiology, Indira Gandhi Institute of Child Health, Bangalore, India
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