Multicentric wilms’ tumor with contralateral recurrence: Comments on management

A 14-month-old child with unilateral Stage I Wilms’ tumor and nephroblastomatosis developed contralateral Wilms’ tumor 28 months after receiving a 10 week course of chemotherapy. Subsequent treatment included intense chemotherapy and heminephreetomy, but the contralateral tumor was anaplastic and the outcome remains uncertain. Metachronous bilateral Wilms’ tumor has an ominous prognosis and usually develops in patients with multifocal Wilms’ tumor precursors (nephroblastomatosis), as was true in this patient. Accurate identification of a patient at risk is a team effort involving the surgeon, pathologist, and radiologist, but optimal management of such cases has not been determined. We advocate immediate postoperative computerized tomography of the contralateral kidney and ultrasonography at intervals of 3 months for at least 2 years for patients at risk. Because chemotherapy may simply delay the emergence of metachronous Wilms’ tumor, meticulous surveillance is mandatory in patients whose exposure to chemotherapy is brief.