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, nontender, and does not cross the midline. The patient is also found to have moderate hypertension. Urinalysis reveals microscopic hematuria.

Other presentations

Uncommon presentations include abdominal pain, fever, hematuria, or anemia.[4] Bilateral or multifocal tumors may be detected in around 10% of patients and tend to present at an earlier age.[2][5] Tumor may occur in an extrarenal location such as the retroperitoneum, pelvic cavity (uterus), inguinal region, testes, thorax, or within teratomas; however, this is 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., generalized weakness, fatigue, ptosis, hypokinesis, dysarthria, urinary retention, facial diplegia, ophthalmoplegia, and autonomic dysfunction).[9] Intracardiac extension of Wilms tumor is rare.[10] Patients with predisposing syndromes may be diagnosed through regular surveillance.[11] Wilms tumors may very rarely present in adolescents and adults.[2]

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