Wilms’ Tumor in the Adolescent and Adult

Nephropathy Associated with Wilms’ Tumor

“…At the time Wilms' tumor was diagnosed, the patient was 13 years old, far older than the oldest of the reported cases, who was 4 years old. Typi cally the greatest incidence of Wilms' tumor (80%) occurs in the first 5 years of life [24][25][26]; beyond the 12th year the incidence of this tumor is very low, under 1% [25,27], Secondly, renal failure marked the abrupt onset of the nephropathy, without any previous signs of renal in volvement. In most cases [5][6][7][8][9][10][11][12][14][15][16], proteinuria or edema are reported as having preceded the signs of renal insufficiency.…”

Wilms’ Tumor in Adults

“…Furthermore salvage chemotherapy with DDP and VP-16 has successfully been applied in 2 patients with anaplastic tumors [30,33]. Since 3-or 4-drug chemotherapy (VCR +ADR±AMD±CPM) has turned out to be ineffective in all patients with anaplastic adult Wilms' tumor, documented in the literature [2, 8,32,34], the combination of DDP and VP-16 might be used as first-line chemotherapy in anaplastic histology disease. Finally, another interesting treatment modality introduced by Kattan et al [31 ] recently should carefully be pursued: Recom-binant interfcron-a at a dose of 5 million units 3 times per week was able to induce a sustained partial remission in a patient with a 5th lung recurrence.…”

Wilms’ Tumor in an Adult Patient

“…Adult Wilms' tumor is a rare entity, 200 cases of which have been described but apparently only 40 cases of them were correctly classified [7][8][9]20]. Kilton et al [8] reviewed the literature in 1979 and established the following criteria for its diagnosis: primary renal neo plasm, primitive blastematous spindle or round cell component, formation of abortive or embryonal tubular or glomeruloid structures, no area of tumor diagnostic of hypernephroma, pictorial confirmation of histology and age > 15 years [8].…”

“…The incidence of hypernephroma and Wilms' tumor in the 2nd decade of life is similar [10], Unfortunately, the current imaging techniques cannot differentiate between these tumors [3]. Nevertheless the Wilms' tumor is frequently hypovascular with some marginal vascularization and hypervascular forms are rare [5,7,9], Computed tomography cannot differen tiate both tumors either [9] even though the finding of a large tumor with areas of necrosis and hemorrhage in the computed tomography and no bone métastasés in the bone scan may suggest the diagnosis [9,10].…”

“…There are, however, two differ ences when applied to adults: (1) the tumor is diagnosed in later stages [11] and (2) stage by stage the prognosis is worse [2,7], This is basically why a more aggressive approach is advised in adults [7]. Some authors recom mend a combination of surgery, radiotherapy and che motherapy (vincristine, actinomycin D) for all the stages of the disease [8,15], The literature, there are not too many patients treated under a multimodal treatment [8,11,16,17].…”