Carmichael Samuel P, Pulliam Joseph F, D'Orazio John A
University of Kentucky College of Medicine, Lexington, KY, USA.
Department of Pathology, University of Kentucky College of Medicine, Lexington, KY, USA.
J Surg Case Rep. 2013 Mar 12;2013(3):rjt012. doi: 10.1093/jscr/rjt012.
We describe the case of a 5-year-old girl whose abdominal pain and distension were caused by Wilms tumor of the kidney. Because of the bilateral nature of her disease, she was spared biopsy or initial nephrectomy as part of her treatment course. Rather, she was treated presumptively for Wilms tumor based primarily on radiologic findings. Neoadjuvant chemotherapy consisting of vincristine, dactinomycin and doxorubicin was given to facilitate nephron-sparing surgery for tumor resection. Her initial chemotherapeutic course was complicated by tumor lysis syndrome manifested by elevated serum uric acid and was treated effectively with hyperhydration and alkalization of intravenous fluids. The patient's disease responded well to chemotherapy, and she underwent successful tumor excision after 12 weeks of chemotherapy. The resected tumor was identified as anaplastic Wilms tumor, illustrating that pathologic identification of Wilms tumor is possible even after multiple cycles of neoadjuvant chemotherapy and marked tumor shrinkage.
我们描述了一名5岁女孩的病例，其腹痛和腹胀由肾母细胞瘤引起。由于她的疾病具有双侧性，在其治疗过程中，她无需进行活检或初次肾切除术。相反，主要基于影像学检查结果，她被推定为患有肾母细胞瘤并接受治疗。给予由长春新碱、放线菌素D和阿霉素组成的新辅助化疗，以促进保留肾单位的肿瘤切除术。她最初的化疗过程因肿瘤溶解综合征而复杂化，表现为血清尿酸升高，并通过静脉输液的水化和碱化得到有效治疗。患者的疾病对化疗反应良好，化疗12周后成功进行了肿瘤切除。切除的肿瘤被鉴定为间变性肾母细胞瘤，这表明即使经过多个周期的新辅助化疗和肿瘤明显缩小，仍有可能对肾母细胞瘤进行病理鉴定。
