Cystic Wilms tumor | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Cystic Wilms tumor

Transverse ultrasound (image 1) and axial T2-weighted image of the abdomen (image 2) show a large multiloculated cystic mass of the left kidney. A second, smaller cystic mass (arrow) is visible within the right kidney. The differential diagnosis for a cystic renal mass in the neonate includes multilocular cystic nephroma and cystic Wilms tumor. In this case, cystic Wilms tumor was confirmed at resection. Wilms tumor is the most common pediatric abdominal malignancy. Typically it appears as a solid mass. Multifocal Wilms tumor can appear in children with predisposition syndromes such as Beckwith Wiedemann syndrome, Denys-Drash syndrome, and WAGR.

More about this case

Resolved

Similar cases

#Nephrectomy for large, cystic #Renal-cell-carcinoma. 1st pic - blue arrow shows normal-appearing kidney, black arrow shows obvious tumor visible from the outside. 2nd pic - bivalved view of "normal" looking portion of kidney. Blue arrow points to uninvolved kidney tissue and black arrow is the mass which takes up the vast majority of the kidney. 3rd pic - cut surface of cystic aspect of mass. You can see the tissue is all necrotic inside of the cystic space. Arrow shows that all of the tissue is involved by tumor and if you look closely, you can see the thin, white renal capsule running along the outer edge. It appears this mass started in the lower pole and grew outward in both directions. Unsure how long this has been growing but it is >20cm and, surprisingly, the patient is only in her 40s.

Abdominal radiograph (image 1) shows calcification, enlargement, and irregularity of the left kidney (arrows). Longitudinal ultrasound (image 2) of the left kidney (arrows) shows a coarsened parenchyma with multiple small cystic spaces. This patient was later diagnosed with nephronophthisis, a medullary cystic kidney disease caused by ciliary dysfunction. Nephronophthisis can be associated with other syndromes including Joubert syndrome, Meckel Gruber syndrome, and skeletal dysplasia such as effusion syndrome or chondroectodermal dysplasia.

Coronal T2 (Image 1) and T1 post-contrast (Image 2) MRI scans show a Wilms tumor (arrow) originating from the upper pole of the left kidney (arrowhead). As the most common renal cancer in childhood, Wilms tumors are usually diagnosed by the age of five and can be part of several syndromes, including Beckwith-Wiedemann, WAGR, Denys-Drash, and Frasier syndromes.

Sagittal T1 (image 1) and T1 postcontrast (image 2) MRI images show a large craniopharyngioma extending from the suprasellar region to the pituitary fossa. The tumor is both cystic (arrowhead) and solid (arrow). Craniopharyngiomas appear as a complex suprasellar mass with calcification and wall enhancement. They follow the 90 percent rule with 90 percent of lesions having a cystic component, 90 percent having calcifications, and 90 percent with tumoral enhancement.