Case history

Case history

A previously healthy, 3-year-old female patient presents with progressive abdominal distension and left, upper quadrant prominence. On examination the mass is firm, smooth, non-tender, and does not cross the mid-line. The patient is also found to have moderate hypertension. Urinalysis reveals microscopic haematuria.

Other presentations

Uncommon presentations include abdominal pain, fever, haematuria, or anaemia.[4] Bilateral or multifocal tumours may be detected in around 10% of patients and tend to present at an earlier age.[2][5] Tumour may occur in an extra-renal location such as the retroperitoneum, pelvic cavity (uterus), inguinal region, testes, thorax, or within teratomas; this is, however, extremely rare.[6][7][8] Shortness of breath or hepatomegaly may indicate metastatic disease.[3] Rarely, children may present with a paraneoplastic syndrome that affects the central and peripheral nervous system (e.g., generalised weakness, fatigue, ptosis, hypokinesis, dysarthria, urinary retention, facial diplegia, ophthalmoplegia, and autonomic dysfunction).[9] Intracardiac extension of Wilms' tumour is rare.[10] Patients with predisposing syndromes may be diagnosed through regular surveillance.[11] Wilms' tumours may very rarely present in adolescents and adults.[2]

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