article · International Journal of Surgery Case Reports
Wilms tumour is the most prevalent paediatric kidney cancer, usually found in children under five years old. Extension of the tumour into the inferior vena cava occurs in four to ten per cent of cases, but spread directly into the heart is exceedingly rare. This report details the management of a three-year-old boy presenting with a massive tumour displaying extensive intravascular spread reaching into the right atrium, treated within a resource-limited facility. Preoperative neoadjuvant chemotherapy successfully achieved significant reduction of both the tumour mass and the associated thrombus. During the surgical procedure, complete transection of the inferior vena cava was performed safely without hemodynamic instability, assisted by pre-existing collateral venous drainage. The patient experienced an uneventful recovery following careful multidisciplinary surgical planning.
Treating advanced paediatric cancers that invade major blood vessels and the heart is exceptionally complex, particularly in hospitals with limited resources. Demonstrating that severe tumour extensions can be reduced with preoperative chemotherapy and safely removed by leveraging natural collateral blood flow provides practical guidance for clinical teams confronting complex paediatric surgeries in low-resource environments.
The abstract does not indicate an application pathway, as it is a single clinical case report focusing on surgical and diagnostic techniques rather than a commercial product or service.
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BACKGROUND: Wilms tumor (nephroblastoma) is the most common renal malignancy in pediatric population, typically diagnosed before the age of 5. Vascular extension into the inferior vena cava (IVC) is seen in approximately 4-10 % of cases, but intracardiac extension, particularly into the right atrium, is exceedingly rare. Managing such advanced tumors in resource-limited settings presents major diagnostic and surgical challenges. CASE PRESENTATION: Herein a rare case of a 3-year-old boy presenting with a giant Wilms tumor exhibiting extensive intravascular spread. Preoperative CT scans of the chest and abdomen revealed significant invasion into the IVC with thrombus extending into the right atrium. The patient underwent neoadjuvant chemotherapy, which led to marked tumor and thrombus reduction. Intraoperatively, the tumor was found adherent to the colon and left common iliac artery but was dissected without arterial injury. A massive intravascular thrombus was identified, forming a wandering thrombus, with evidence of collateral venous drainage indicating longstanding IVC obstruction. Cavotomy was performed, and the IVC was completely transected without hemodynamic compromise due to collateralization. The surgery was uneventful, and the patient recovered in the Pediatric Intensive Care Unit (PICU). DISCUSSION: This case highlights the complexity of managing extensive Wilms tumor thrombus with intracardiac involvement in a low-resource environment. It underscores the role of neoadjuvant chemotherapy and surgical planning in achieving curative resection. CONCLUSION: Multidisciplinary coordination, preoperative chemotherapy, and understanding of collateral circulation allowed successful management of this rare and complex Wilms tumor case in a resource-constrained setting.
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DOI: 10.1016/j.ijscr.2025.111611
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