Adolescent Extra-renal Wilms’ Tumour: Rare Manifestation of Retroperitoneal Tumor with Hepatomegaly in District Hospital during Pandemic COVID-19 Era

Abstract

Wilms’ tumour or nephroblastoma is the most common primary renal neoplasm in children, however, it is rarely documented within adolescent age group. Generally, only a few cases have been reported in adolescents even more in extrarenal presentations. This paper discusses a case of a 15-year-old adolescent with a huge hepatomegaly. Ultrasonography finding suggested liver tumour possibly hepatoblastoma due to the age. CT scan findings on the other hand suggested retroperitoneal sarcoma. Diagnosis using CT scan for retroperitoneal tumor is often challenging but further tests such as MRI scan was limited due to restricted resources and modalities in the district hospital during covid 19 pandemic. Dilemma of establishing diagnosis through a simple procedure that only acquired expert interventional radiologist was limited due to COVID-19 pandemic. Thus, decision of open biopsy was made for the retroperitoneal mass. Consequently, a complete tumour resection was made for symptomatic relief in view of encapsulated mass noted intra-operatively and pathological staging confirmed as metastatic stage 1 extra-renal Wilms tumour. Radiological staging confirmed of stage 4 disease with lung metastasis in which required multiple course of adjuvant chemotherapy and close follow up. Reassessment CT post-chemotherapy show diseases progression with residual segment VII local liver disease and increasing number of multiple lung metastasis. Wilms’ tumour is rare in adolescents, and extra-renal manifestations are even less common. It is essential for general surgeon to maintain a high index of clinical suspicion for Wilms’ tumour in adolescents who present with a large retroperitoneal mass and/or abdominal pain.