Differential diagnosis. Clinical Presentation

Clinical Presentation

Most children with WT present between the ages of 2 and 4 years with an asymptomatic abdominal mass, often discovered by either a parent or pediatrician (Image 9.17). Nonpalpable tumors are typically discovered by ultrasonography during evaluation for abdominal pain. Gross hematuria has been reported in 18.2% of patients and microscopic hematuria in 24.4%. 10% of children with WT have coagulopathy, and 20-25% present with hypertension because of activation of the renin-angiotensin system. Fever, anorexia, and weight loss occur in 10%. Extension of tumor thrombus into the renal vein can obstruct the spermatic vein and result in a left varicocele and, in rare cases, tumor extension into the atrium may produce cardiac malfunction. Tumor rupture and hemorrhage are also infrequent events that can present as an acute abdomen.

Image 9.17 Asymptomatic abdominal mass in patient with Wilms` tumor

The differential diagnosis for an abdominal mass includes neuroblastoma, hepatoblastoma, rhabdomyosarcoma, and lymphoma. Neuroblastoma is the most common solid abdominal tumor in children. One clinical observation to help distinguish between WT and neuroblastoma is that children with neuroblastoma are often ill because of extensive metastatic disease at presentation. In contrast, children with WT are generally healthy toddlers with a palpable abdominal mass.

Дата добавления: 2014-10-15