Published online Aug 24, 2019. doi: 10.5306/wjco.v10.i8.293
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
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.
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.
Abdominal mass, dilated cardiomyopathy and hypertension can indicate Wilms tumor in pediatric patients. Chemotherapy and tumor removal achieve successful treatment.
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.