Pulmonary metastases of adult Wilms' tumor 17 years after the primary site.

摘要

Wilms' tumor accounts for most childhood renal neoplasms, and it is the third most common solid cancer in children under the age of 10 years. However, it infrequently occurs in adults, and only sporadic reports of isolated adult Wilms' tumor appear in the literature.A 47-year-old woman was admitted to our hospital after a chest radiograph showed a big shadow in the upper left lung (Figure El). Chest computed tomography (CT) confirmed a mass sized 7 X 10 X 8 cm that was located in the left upper lobe (LUL) with atelectasis of the LUL (Figure 1) and revealed enlargement of the ipsilateral lymph nodes and secondary nodules in the left lower lobe and the right lower lobe at a maximum diameter of 3 cm. Thrombocytopenia that had started 2 months previously initiated diagnostic investigation. The patient was an ex-smoker (20 packets-years), with a history of left nephrectomy 17 years previously because of a stage II Wilms' tumor. Transbronchial needle aspiration through the left upper lobar bronchus set the diagnosis of metastatic Wilms' tumor with relatively good differentiation. The complementary diagnostic work-up (abdominal and brain CT scan and skeletal bone scanning) did not detect any further lesions, and the patient underwent 2 cycles of chemotherapy. A new chest CT scan found a decrease in the size of the findings in both lungs, which was indicative of the response of the mass to the chemotherapy. Surgical excision of the tumor was decided, and a 2-stage procedure was chosen as appropriate. A left thoracotomy was performed first because of the size of the tumor in the LUL and the atelectasis. Left upper lobectomy and wedge resection of 2 lesions of the left lower lobe was required to remove all metastases from the left lung. Histologic examination revealed metastatic Wilms' tumor to the LUL and left lower lobe, infiltrating the lung parenchyma, the lobar bronchus, the pleura, and 3 peribronchial lymph nodes.