Wilms tumor with multiple bone and lung metastases in a two-year-old boy

ABSTRACT Introduction: Wilms tumor is the most common renal tumor encountered in children with more than 80% was diagnosed below the age of five years. The incidence of metastases of Wilms tumor is approximately 10%. The primary distant site for metastases is the lung; hepatic and lymph nodal metastases are much less common and bone metastases being extremely rare. Case Report: We present a two year-old boy with masses on the head, right shoulder and right knee with history of palpable masses two month before on his left abdomen and underwent a nephrectomy. The microscopic examination after tumor excision showed unfavorable Wilms tumor but he never went for chemotherapy. Chest X-ray revealed a solitary nodule on the right paracardiac region and the destruction of the right scapular bone very likely the process of metastases. Computed tomography scan of head revealed soft tissue masses and destructed bone underneath. Microscopic examination in biopsy of the masses at head and right shoulder revealed hypercellular groups of neoplastic cells suitable for small round cell tumor suggests a metastasis of Wilms tumor. He planned to have 24 weeks of chemotherapy consist of doxorubicin, vincristine, cyclophosphamide, and etoposide. After 17 weeks of treatment, he experienced clinical improvement. Conclusion: Putu Diah Vedaswari1, Ketut Ariawati1 Affiliation: 1Department of Child Health, Medical School of Udayana University, Denpasar, Bali, Indonesia. Corresponding Author: Putu Diah Vedaswari, Denpasar, Bali, Indonesia, 80119; Email: diah.vedaswari@gmail.com Received: 14 August 2017 Accepted: 19 September 2017 Published: 12 October 2017 PEER REVIEWED | OPEN ACCESS Metastases to the bone and lung in Wilms tumor are extremely rare. The manifestation can be as a mass with destructed bone underneath with cytomorphology suitable for small round cell tumor. Keywords: Bone metastases, Children, Lung metastases, Wilms tumor