V7-08: Laparoscopic Nephrectomy for Prenatally diagnosed Wilms' Tumor
The most common diagnosis of neonatal renal mass is congenital mesoblastic nephroma. However, Wilms' tumor has been reported sporadically in the literature. We report the diagnosis, management and surgical approach to a prenatally diagnosed Wilms' tumor.
The patient was a newborn female found to have an abnormal renal ultrasound on routine 2nd trimester prenatal ultrasound. The mass was seen on subsequent ultrasounds at 32 weeks and again 37 weeks. Neonatal ultrasound confirmed the mass. A contrast-enhanced CT scan was performed on day 10 of life, revealing a centrally-located, multifocal, enhancing left renal mass. The remainder of staging work up was negative. She underwent a Laparoscopic radical left nephrectomy with lymph node sampling on day 26 of life. Intraoperative frozen pathology was consistent with Wilms' tumor; therefore, a port-a-cath was placed under the same anesthetic for administration of adjuvant chemotherapy. The case presentation and surgical management are described in the video.
The final pathology revealed favorable histology Stage II Wilms' tumor. There was extension into the renal sinus. Surgical margins were negative. There was no lymph node involvement. The patient was dismissed on post operative day 1. She received adjuvant chemotherapy with Vincristine and Dactinomycin based on the EE4A regimen. Port placement was performed using the novel HIdES (Hidden Incision Endoscopic Surgery); which renders the scar profile nonvisible if the patient is wearing a bathing suit.
Although the most common cause of neonatal renal mass is nephrogenic mesoblastic nephroma, Wilms' tumor cannot be excluded. Therefore, a timely management is warranted. A minimally-invasive surgical approach to radical nephrectomy and lymph node sampling is safe and feasible in the neonatal period.