KIDNEY URETER Tumour Wilms

Wilm's Tumour (Adenomyosarcoma Nephroblastoma) 

The  tumour  is  most  likely  present  at  birth  and  manifests

clinically when the patient is still under the age of two.

The  usual presentation is a unilateral flank  mass.  Haematuria,

weight loss and pain are usual manifestations and occur later  in

the natural history of the disease.

A plain abdominal radiograph shows displacement of the intestinal

gas  shadows  to the contralteral side and  obliteration  of  the

psoas shadow on the side of the lesion.

Excretory urography may show a small rim of displaced functioning

renal tissue the distinct IVP features are shown in Fig. 25.11c.

Kidney  on  the side of the lesion may not be visualised  by  the

intravenous pylogram.

Ultrasonography  can differentiate a hydronephrosis from a  solid

Wilm's  tumour and a CT scan can establish the diagnosis and  aid

staging the disease.

Treatment usually consistes of transperitoneal surgical  excision

followed by postoperative radiation therapy of chemotherapy.

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