AssessmentsNephroblastoma (Wilms tumor)
Nephroblastoma (Wilms tumor)
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 3-year-old boy is brought to the clinic because of irritability, vomiting, fever, and abdominal pain for the past month. His temperature is 39.2°C (102.56°F), pulse is 110/min, respirations are 25/min, and blood pressure is 110/70 mm Hg. Physical examination shows an upper right quadrant abdominal mass on palpation. A CT scan image is obtained and is shown below. Which of the following is the most likely diagnosis?
Contributors:Tanner Marshall, MS
Wilms’ tumor, or nephroblastoma, is a type of kidney tumor composed of metanephric blastemal cells, cells involved in kidney development, and is the most common malignant kidney tumor in children; only rarely is it seen in adults.
Wilms’ tumor is thought to be caused by mutations in genes responsible for normal genitourinary development, which includes the kidneys as well as the gonads, typically the genes are located around 11p13—which means chromosome 11, the short arm p, region 1, band 3.
Mutations that result in a “loss of function” of WT1, like deletions, for example, seem to lead to the development of tumor cells seen with Wilms’ tumor.
Wilms’ tumors as a result of WT1 mutations are sometimes part of a developmental syndrome, meaning other abnormalities are present as well, likely because of deletion or mutation of other genes in addition to WT1.
For example, in WAGR syndrome, a mutation in the 11p13 region causes deletion of both WT1 and the PAX6 genes, among others, which leads to Wilms’ tumor and Genitourinary malformations as a result of WT1 deletion, as well as Aniridia (which is absence of iris) and intellectual disability (which is formerly referred to as mental Retardation), as a result of PAX6 deletion.
Another gene, WT2, also located on chromosome 11, seems to also be involved with other Wilms’ tumor-containing syndromes, like Beckwith-Wiedemann syndrome, which includes Wilms’ tumor, macroglossia, organomegaly, and hemihypertrophy.