Teratoid Wilms’ tumor in a child: A report of a rare case
A 2-year-old male with a complaint of right sided abdominal mass of 1 month duration revealed a palpable right abdominal mass on the physical examination. Ultrasonographic examination of abdomen presented a large, sharply demarcated predominantly hyperechoic mass of 7 cm × 5.5 cm × 4 cm in right para vertebral region in the location of normal kidney with areas of hypoechogenicity. No normal kidney tissue was identified on the right side. No calcification is noted. No intravascular echogenic focus was identified on color Doppler sonography. Left kidney was normal in position and echotexture. However, computed tomography scan was not performed as the patient was very poor to afford the test. Pre-operative routine investigations; serum urea, creatinine, and the blood urea nitrogen were normal. Serum alpha feto-protein levels were within normal limits. With a provisional diagnosis of Wilms’ tumor, right sided nephrectomy was carried out and the specimen was sent for the histopathological examination.\nOn gross examination, the tumor measured 6.5 cm × 5 cm × 4 cm and was weighing 250 g. It was well-circumscribed and encapsulated. Cut sections presented homogenous gray-white tumor tissue, soft, and granular in the texture. Ureter and renal veins were not involved by the tumor.\nMicroscopically multiple sections examined from different areas showed classic triphasic combination of blastemal, stromal, and epithelial cell types []. The tightly packed blue cells are the blastemal elements, immature tubule in the picture is the epithelial element and spindle cells are stromal elements. The heterologous elements are predominant and composed of squamous epithelium with abundant keratin pearl formation [Figures and ] and constitute about 75% of the area from where the sections were examined.\nConsidering the above histopathological features, a diagnosis of teratoid Wilms’ tumor was arrived. The patient was referred to the medical oncology department. No post-operative chemotherapy was advised to consider the diagnosis of teratoid Wilms’ tumor. Patient was doing well 1 year post-surgery. After that, the patient was not in contact for further follow-up.