Management of the Debilitated Child with Massive Wilms' Tumor

Abstract

Five Saudi Arabian children, 2 to 6 years of age, presented with far advanced Wilms' tumors impairing staging and treatment according to the recommendations of the American National Wilms' Tumor Study Group (NWTSG). These patients were not eligible for general anesthesia and surgery because of their poor general condition. The tumours were locally advanced with or without dissemination. The term "Stage S" to signify special was introduced to describe these patients. Additionally, a protocol was implemented including an initial course of combined chemotherapy, irradiation to involved areas, and total parenteral nutrition (TPN) followed by total excisional surgery. Of the five patients in this study, two are disease-free, two died of gastroenteritis while in complete remission, and one developed pulmonary metastases and underwent modified therapy. Although the number of cases is small, the results indicate that for patients with massive Wilms' tumor and malnutrition, the outcome may be improved by initial chemotherapy, irradiation, and TPN in preparation for delayed surgery after reduction of tumor size and correction of malnutrition are achieved.

Fine Needle Aspiration Biopsy Diagnosis of Renal Masses in Children: A Brief Review

“…6 Furthermore, in a patient whose tumor is relatively advanced and therefore unsuitable for surgical resection, fine needle aspiration biopsy (FNAB) diagnosis may help in initiating proper chemotherapy or radiation therapy in order to reduce the tumor size, thus rendering it amenable to surgical resection. 7 Several recent studies have shown that FNAB may be an extremely useful technique for diagnosing renal neoplasms. [8][9][10][11][12][13][14][15][16][17] However, definitive FNAB diagnosis of these tumors requires a thorough knowledge of the various histologic patterns encountered in these tumors and a clear understanding of corresponding histologic and cytologic correlations.…”