Bilateral Nephromegaly Simulating Wilms Tumor

Abstract

A 7-year-old boy was referred with a provisional diagnosis of bilateral Wilms tumor. Peripheral smear revealed elevated leukocyte count with 90% blasts. Bone marrow aspiration and biopsy were hypercellular with sheets of blasts. Immunohistochemistry on paraffin sections showed a pre-B phenotype of acute lymphoblastic leukemia. Computerized tomographic scan of the abdomen showed moderate bilateral renal enlargement. Ultrasound-guided fine needle aspiration cytology of both kidneys showed blasts similar to those seen in the bone marrow. Finally, a diagnosis of pre-B acute lymphoblastic leukemia infiltrating both the kidneys was made. This case is being presented because of its rarity.

Rare Presentation of Pediatric Acute Lymphoblastic Leukemia: Nephromegaly at Time of Diagnosis

“…Leukemic infiltration of the kidneys is more common in the late stage of ALL in all age groups, and is reported to occur in 7-42% of childhood leukemia cases [3][4][5][6]. In contrast, isolated bilateral symmetrical renal enlargement as a primary finding in children with ALL is rare [1,2]. Sometimes leukemic infiltration of the kidneys is detected incidentally by imaging during the course of disease or during testing prior to treatment.…”

“…The kidneys may also be infiltrated with leukemic cells and this form of involvement is fairly common in pediatric leukemia; however, there are only a few reports of children with palpable renal enlargement at initial presentation [1][2][3]. We report the case of a young girl who presented with unexplained bilateral renal enlargement.…”

Acute Lymphoblastic Leukemia: an Unusual Cause of Bilateral Nephromegaly At Presentation

“…Akut lenfositer lösemi tanısı alan hastaların, tanı sonrası yapılan incelemelerde %8-16'sının böbrek-lerinde lösemik infiltrasyon görülmektedir (3) . Tanı anın-da bilateral nefromegali olması ise oldukça ender bir bulgudur ve literatürde az sayıda vaka bildirilmiştir (1,(5)(6)(7) . Akut lenfoblastik lösemi ateş, hâlsizlik, solukluk, kemik ağrısı, kilo kaybı, peteşi, nötropeni, trombositopeni gibi farklı klinik bulgularla ortaya çıkabilir (2,8) .…”

“…Bu tutulum lösemik infiltrasyon, basit hipertrofi veya hiperplazi şeklinde olmaktadır (4) . Akut lenfositer lösemide tanı öncesi bilateral nefromegali oldukça ender olup, literatürde yalnızca birkaç vaka bildirilmiştir (1,(5)(6)(7) . Bu makalede karında şişkinlik nedeniyle başvuran, bilateral nefromegali saptanan ve pre-B hücreli ALL tanısı alan vaka sunularak nefromegalinin ayırıcı tanısında löseminin de yer alması gerektiği vurgulanmıştır.…”

Bilateral nephromegaly and arthritis: A rare presentation of acute lymphoblastic leukemia

“…Although renal infiltration is relatively frequent in acute lymphoblastic leukemia, clinically palpable renal enlargement occurs only in 2% -5% of cases. Isolated renal enlargement as a primary presenting feature of ALL is extremely rare [2][3][4][5]. Renal enlargement in a case of leukemia may be due to leukemic infiltration or simple hypertrophy or hyperplasia of cells [6].…”