Adult Wilms’ Tumor during Pregnancy A Rare and Challenging Clinical Scenario with Literature Review
Main Article Content
Keywords
Adult, Wilms tumor, nephroblastoma, pregnancy, southeast asia
Abstract
Wilms’ tumor (nephroblastoma) is a predominantly pediatric malignancy and is exceedingly rare in adults, particularly during pregnancy. We report a case of a 26-year-old South Asian woman diagnosed with a left-sided large retroperitoneal mass incidentally during the second trimester of pregnancy. The patient underwent radical nephrectomy during pregnancy, and histopathology and immunohistochemistry confirmed high-risk nephroblastoma. The patient was closely monitored throughout the pregnancy period and delivered a healthy preterm infant via cesarean section. Systemic chemotherapy was started after the delivery. Despite multimodal management, including surgery and systemic chemotherapy, the disease showed aggressive progression with widespread metastases. The patient required multiple lines of chemotherapy and palliative care, with partial symptomatic improvement. This case highlights the diagnostic and therapeutic challenges of managing adult Wilms’ tumors during pregnancy, the importance of multidisciplinary care, and the need for timely intervention to optimize maternal and fetal outcomes.
References
1. Modi, S., Woi Tiang, K., Inglis, P. & Collins, S. Adult Wilms’ Tumour: Case Report and Review of Literature. J. Kidney Cancer VHL 3, (2016).
2. Geethamani, V., Kusuma, V., Gowda, K. M. S. & Saini, M. L. Adult Wilms’ tumour; a case report with review of literature. Diagn. Pathol. 1, (2006).
3. Mitry, E., Ciccolallo, L., Coleman, M. P., Gatta, G. & Pritchard-Jones, K. Incidence of and survival from Wilms’ tumour in adults in Europe: Data from the EUROCARE study. Eur. J. Cancer 42, (2006).
4. Gooskens, S. L. et al. The clinical relevance of age at presentation in nephroblastoma. in Wilms Tumor (2016). doi:10.15586/codon.wt.2016.ch2.
5. McLaughlin, J. K., Lipworth, L. & Tarone, R. E. Epidemiologic Aspects of Renal Cell Carcinoma. Semin. Oncol. 33, (2006).
6. Izawa, J. I. et al. Prognostic variables in adult Wilms tumour. Canadian Journal of Surgery 51, (2008).
7. Kalapurakal, J. A. et al. Treatment outcomes in adults with favorable histologic type Wilms tumor - An update from the National Wilms Tumor Study Group. Int. J. Radiat. Oncol. Biol. Phys. 60, (2004).
8. Kattan, J., Tournade, M. F., Culine, S., Terrier-Lacombe, M. J. & Droz, J. P. Adult Wilms’ tumour: Review of 22 cases. Eur. J. Cancer 30, (1994).
9. Reinhard, H. et al. Wilms’ tumor in adults: Results of the Society of Pediatric Oncology (SIOP) 93-01/Society for Pediatric Oncology and Hematology (GPOH) Study. Journal of Clinical Oncology 22, (2004).
10. Terenziani, M. et al. Adult Wilms’ tumor: A monoinstitutional experience and a review of the literature. Cancer vol. 101 Preprint at https://doi.org/10.1002/cncr.20387 (2004).
11. Arrigo, S., Beckwith, J. B., Sharples, K., D’angio, G. & Haase, G. Better survival after combined modality care for adults with Wilms’ tumor. A report from the national Wilms’ tumor study. Cancer 66, (1990).
12. Byrd, R. L., Evans, A. E. & D’Angio, G. J. Adult Wilms tumor: Effect of combined therapy on survival. Journal of Urology 127, (1982).
13. Huszno, J., Starzyczny-Słota, D., Jaworska, M. & Nowara, E. Adult wilms’ tumor - Diagnosis and current therapy. Central European Journal of Urology vol. 66 Preprint at https://doi.org/10.5173/ceju.2013.01.art12 (2013).
14. Sepenu, P. et al. Disseminated adult Wilms tumor in pregnancy: Leveraging multidisciplinary care in a low-resource setting. International Journal of Gynecology and Obstetrics vol. 165 Preprint at https://doi.org/10.1002/ijgo.15157 (2024).
15. Brown, J. T. et al. Multidisciplinary Care of Adult Wilms’ Tumor During Pregnancy: A Case Report and Review of the Literature. Clin. Genitourin. Cancer 18, (2020).
16. Sakthivel, V., Ismail Z, A. & Vijayabalan, D. Recent Improvements in Adult Wilms Tumor Diagnosis and Management: Review of Literature. J. Kidney Cancer VHL 10, (2023).
17. Eibye, S., Kjær, S. K. & Mellemkjær, L. Incidence of pregnancy-associated cancer in Denmark, 1977-2006. Obstetrics and Gynecology 122, (2013).
18. Lee, Y. Y. et al. Incidence and outcomes of pregnancy-associated cancer in Australia, 1994-2008: A population-based linkage study. BJOG: An International Journal of Obstetrics and Gynaecology vol. 119 Preprint at https://doi.org/10.1111/j.1471-0528.2012.03475.x (2012).
19. Amant, F. et al. Long-term cognitive and cardiac outcomes after prenatal exposure to chemotherapy in children aged 18 months or older: An observational study. Lancet Oncol. 13, (2012).
20. Amant, F. et al. Pediatric Outcome After Maternal Cancer Diagnosed During Pregnancy. Obstetrical and Gynecological Survey vol. 71 Preprint at https://doi.org/10.1097/01.OGX.0000481129.79021.94 (2016).
21. de Haan, J. et al. Oncological management and obstetric and neonatal outcomes for women diagnosed with cancer during pregnancy: a 20-year international cohort study of 1170 patients. Lancet Oncol. 19, (2018).
22. Van Calsteren, K. et al. Cancer during pregnancy: An analysis of 215 patients emphasizing the obstetrical and the Neonatal outcomes. Journal of Clinical Oncology 28, (2010).
23. Lu, D. et al. Maternal cancer during pregnancy and risks of stillbirth and infant mortality. Journal of Clinical Oncology 35, (2017).
24. Langagergaard, V. et al. Birth outcome in women with breast cancer. Br. J. Cancer 94, (2006).
25. Loibl, S. et al. Treatment of breast cancer during pregnancy: An observational study. Lancet Oncol. 13, (2012).
