Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Aug 24, 2019; 10(8): 293-299
Published online Aug 24, 2019. doi: 10.5306/wjco.v10.i8.293
Wilms tumor with dilated cardiomyopathy: A case report
Saviga Sethasathien, Chane Choed-Amphai, Kwannapas Saengsin, Lalita Sathitsamitphong, Pimlak Charoenkwan, Kanokkan Tepmalai, Suchaya Silvilairat
Saviga Sethasathien, Kwannapas Saengsin, Suchaya Silvilairat, Division of Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Chane Choed-Amphai, Lalita Sathitsamitphong, Pimlak Charoenkwan, Division of Hematology and Oncology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Kanokkan Tepmalai, Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Author contributions: Sethasathien S and Silvilairat S identified the patient, designed the study, and wrote the manuscript; Choed-Amphai C, Sathitsamitphong L and Charoenkwan P wrote the manuscript; Choed-Amphai C, Saengsin K, Sathitsamitphong L, Charoenkwan P and Tepmalai K provided study materials; All authors read and approved the final manuscript.
Informed consent statement: The patient’s parent gave written informed consent for the publication of this case.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Suchaya Silvilairat, MD, Associate Professor, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand. asilvilairat@gmail.com
Telephone: +66-89-7612855Fax: +66-53-936461
Received: February 22, 2019
Peer-review started: February 24, 2019
First decision: June 17, 2019
Revised: July 3, 2019
Accepted: July 30, 2019
Article in press: July 30, 2019
Published online: August 24, 2019
Abstract
BACKGROUND

Wilms tumor is the most common renal malignancy in childhood. It occurs primarily between the ages of 2 and 5 years. The usual manifestations are abdominal mass, hypertension, and hematuria. The case presented here had an unusual presentation, with dilated cardiomyopathy and hypertension secondary to the Wilms tumor.

CASE SUMMARY

A 3-year-old boy presented with a 5-d history of irritability, poor appetite, and respiratory distress. His presenting clinical symptoms were dyspnea, tachycardia, hypertension, and a palpable abdominal mass at the left upper quadrant. His troponin T and pro-B-type natriuretic peptide levels were elevated. Echocardiography demonstrated a dilated hypokinetic left ventricle with an ejection fraction of 29%, and a suspected left renal mass. Computed tomography scan revealed a left renal mass and multiple lung nodules. The definitive diagnosis of Wilms tumor was confirmed histologically. The patient was administered neoadjuvant chemotherapy and underwent radical nephrectomy. After surgery, radiotherapy was administered, and the adjuvant chemotherapy was continued. The blood pressure and left ventricular function normalized after the treatments.

CONCLUSION

Abdominal mass, dilated cardiomyopathy and hypertension can indicate Wilms tumor in pediatric patients. Chemotherapy and tumor removal achieve successful treatment.

Keywords: Dilated cardiomyopathy, Heart failure, Hypertension, Wilms tumor, Case report

Core tip: Wilms tumor is the most common renal malignancy in childhood. The usual manifestations are abdominal mass, hypertension, and hematuria. A 3-year-old male presented with an unusual clinical profile of dilated cardiomyopathy and hypertension secondary to Wilms tumor. Echocardiography demonstrated a dilated left ventricle with poor contractility and a suspected left renal mass. The definitive diagnosis of Wilms tumor was confirmed histologically. Wilms tumor should be included in the differential diagnosis of any pediatric patient with dilated cardiomyopathy and abdominal mass, regardless of the presence of hypertension. Treatment of chemotherapy and tumor removal resulted in an improvement of left ventricular function.