Wilm's tumor with intracardiac extension causing dynamic tricuspid valve obstruction: An anesthetic challenge

Kajal, Kamal; Munirathinam, Ganesh Kumar; Mandal, Banashree; Gandhi, Komal; Singh, Harkant; Kanojia, Ravi Prakash

doi:10.4103/sja.sja_472_17

Cited by 4 publications

(7 citation statements)

References 4 publications

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“…Our study suggests that young and high-risk WT patients who receive intensive treatment regimens (i.e., for bilateral WT) seem to require unplanned PICU admission more often. This finding has not been described previously and is not consistently reflected in the previously reported cases of WT patients with complications requiring PICU admission [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. In the SIOP93-01 and SIOP2001 studies, patients aged 6 months to 2 years were shown to have an excellent survival, with a higher event-free survival when compared to older age groups [ 2 , 3 , 32 ].…”

Section: Discussioncontrasting

confidence: 71%

“…Case reports confirm that children with WT may require unplanned intensive care treatment due to various tumor- and treatment-related emergencies. These cases revealed not only relatively well-known emergencies associated with WT at presentation, such as malignant hypertension and extensive (intracardial) tumor thrombus, but also postoperative hemorrhage, cardiomyopathy and hepatotoxicity, intracranial bleeding, and seizures [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

Steur

Raymakers-Janssen

Kneyber

et al. 2022

Cancers

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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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Section: Discussioncontrasting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

Steur

Raymakers-Janssen

Kneyber

et al. 2022

Cancers

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“…Wilms tumor, also known as nephroblastoma [2], is the most common primary renal [1] tumor in children, accounting for 95% of all renal malignancies in children [3]. It is the fourth most common pediatric cancer overall [4].…”

Section: Discussionmentioning

confidence: 99%

Untitled

2023

NCP

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“…In sub-Saharan Africa, WT is reported to be the most common solid tumor among children [3] . The typical clinical presentation of WT is an abdominal mass, with or without constitutional symptoms [4,5] . In low and middle countries (LMICs) like Nigeria, however, patients typically present late, by which time the disease has extended beyond the renal bed [3,4,6] .…”

Section: Introductionmentioning

confidence: 99%

“…Patients with metastasis to the heart may be asymptomatic and identified during routine echocardiography. Others may present with abnormal cardiac findings such as dynamic tricuspid valve obstruction, or cardiogenic shock [5,6,8,9] . Wilms tumour is highly chemo-sensitive and curable, with 5-year overall survival (OS) and event-free survival (EFS) in developed countries approaching 90% with the current multi-modal treatment strategies.…”

Section: Introductionmentioning

confidence: 99%

Left Atrial Metastasis of Wilms Tumour in Abeokuta, Nigeria: A Case Report

SK,

MM,

et al. 2024

IJAMRS

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Background: Wilms tumor (WT) is the most common renal malignancy, and also the second most common intra-abdominal cancer of childhood globally. It typically presents as an abdominal mass. In low-and-middle-income countries, however, patients tend to present with advanced disease which has extended beyond the renal bed. Evidence of metastasis has been reported in about 12% of WT cases, with the lungs being the most common site in more than 80% of advanced cases. Less frequently disease may spread to the liver, bones, brain, and rarely the heart. Objective: To highlight left atrial metastasis as a rare complication of WT, as well as, emphasize the importance of echocardiography as a component of routine evaluation of suspected cases of WT. Methods: We present a 5-year-old female who presented with a three-year history of left-sided abdominal swelling, one-year history of weight loss and recurrent abdominal pain, and three-week history of cough. Results: Abdominopelvic CT scan and ultrasound were both in keeping with left nephroblastoma. Echocardiogram revealed a left intra-atrial mass measuring 14mm X 17mm. Treatment/Outcome She was diagnosed with Stage IV nephroblastoma, commenced on neo-adjuvant chemotherapy. A repeat echocardiography was planned after the completion of the neo-adjuvant chemotherapy schedule. She however died during the 4th week of treatment. Discussion Wilms tumour has been reported to invade vascular structures with consequent extension to the right atrium and ventricle. Left atrial involvement in WT is a rare but documented complication of the disease, and could be an asymptomatic, incidental finding as it occurred in the index case. Conclusion and Recommendations Wilms tumour patients should have echocardiography done as part of their routine evaluation to provide baseline information about cardiac function prior to the commencement of potentially cardiotoxic medications, and also to screen for intra-cardiac extension of the disease.

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Wilm's tumor with intracardiac extension causing dynamic tricuspid valve obstruction: An anesthetic challenge

Cited by 4 publications

References 4 publications

Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy

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Left Atrial Metastasis of Wilms Tumour in Abeokuta, Nigeria: A Case Report

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