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Localized Nephroblastoma in Adults: Is Surgery Enough? Case Report and Literature Review

Mohammed Alae Touzani, Yddoussalah Othmane, Souhail Regragui, Amine Slaoui, Fouad Zouaidia, Tariq Karmouni, Khalid El Khader, Abdellatif Koutani, Ahmed Ibn Attya Andaloussi

Introduction: Nephroblastoma or Wilms’ Tumor (WT) is the most common kidney tumor in children. While its incidence is close to 8 cases per million children, it is only 0.2 cases per million adults. In fact, no more than 300 cases have been described in the English or French literature. And while the treatment of nephroblastoma is very well codified in children, its rare incidence in adults leads to a lack of specific treatment regimen.

Observation: A 28-year-old female, with no medical history, presented with right flank pain for 4 months. Clinical examination revealed a palpable kidney. CT scan found a large heterogeneous renal mass measuring 15 × 14 × 11 cm without evidence of adjacent structure ’ s infiltration. The patient underwent an open transperitoneal radical nephrectomy. Pathologic examination revealed a nephroblastoma. Due to lack of financial means, she was unable to have adjuvant chemotherapy. A control CT scan performed at 6 months revealed multiples recurrences. The patient died before being able to benefit from chemotherapy.

Conclusion: This case illustrates the importance of adjuvant chemotherapy, despite R0 surgery in a localized nephroblastoma. The key to treat nephroblastoma is, first, nephrectomy, then chemotherapy, whatever the stage. Staging only plays a role in the chemotherapy protocol.