案例
一名先前健康的 3 岁女性患者因进行性腹胀和左上腹部突出前来就诊。检查时,该肿块坚固、平滑、无压痛,且未穿过中线。还发现该患者有中度高血压。尿液分析提示镜下血尿。
其他表现
少见表现包括腹痛、发热、易激怒、苍白或贫血。[1]D'Angio GJ. The National Wilms Tumor Study: a 40 year perspective. Lifetime Data Anal. 2007;13:463-470.http://www.ncbi.nlm.nih.gov/pubmed/18027087?tool=bestpractice.com肿瘤很少出现在双侧或多个病灶。[11]Coppes MJ, de Kraker J, van Dijken PJ, et al. Bilateral Wilms tumor: long-term survival and some epidemiological features. J Clin Oncol. 1989;7:310-315.http://www.ncbi.nlm.nih.gov/pubmed/2537383?tool=bestpractice.com[12]Montgomery BT, Kelalis PP, Blute ML, et al. Extended followup of bilateral Wilms tumor: results of the National Wilms Tumor Study. J Urol. 1991;146:514-518.http://www.ncbi.nlm.nih.gov/pubmed/1650403?tool=bestpractice.com[13]Ritchey ML, Shamberger RC, Hamilton T, et al. Fate of bilateral renal lesions missed on preoperative imaging: a report from the National Wilms Tumor Study Group. J Urol. 2005;174:1519-1521.http://www.ncbi.nlm.nih.gov/pubmed/16148643?tool=bestpractice.com[14]Horwitz JR, Ritchey ML, Moksness J, et al. Renal salvage procedures in patients with synchronous bilateral Wilms tumors: a report from the National Wilms Tumor Study Group. J Pediatr Surg. 1996;31:1020-1025.http://www.ncbi.nlm.nih.gov/pubmed/8863224?tool=bestpractice.com肿瘤可能出现于肾外部位,例如腹膜后腔、骨盆腔(子宫)、腹股沟区、睾丸、胸腔或畸胎瘤内;但这极为罕见。[15]Rasheed K, O'Meara A, Kelleher J, et al. Extrarenal Wilms' tumor. Eur J Pediatr Surg. 1993;3:121-123.http://www.ncbi.nlm.nih.gov/pubmed/8391838?tool=bestpractice.com[16]Coppes MJ, Wilson PC, Weitzman S. Extrarenal Wilms' tumor: staging, treatment, and prognosis. J Clin Oncol. 1991;9:167-174.http://www.ncbi.nlm.nih.gov/pubmed/1845874?tool=bestpractice.com呼吸困难、淋巴结肿大、肝肿大或骨压痛可能提示转移性疾病。[17]Grundy P, Breslow N, Green DM, et al. Prognostic factors for children with recurrent Wilms' tumor: results from the Second and Third National Wilms' Tumor Study. J Clin Oncol. 1989;7:638-647.http://www.ncbi.nlm.nih.gov/pubmed/2540289?tool=bestpractice.com[18]Perlman EJ. Pediatric renal tumors: practical updates for the pathologist. Pediatr Dev Pathol. 2005;8:320-338.http://www.ncbi.nlm.nih.gov/pubmed/16010493?tool=bestpractice.com罕见情况下,儿童可出现影响中枢和周围神经系统的副肿瘤综合征(例如全身无力、疲乏、上睑下垂、运动功能减退、构音障碍、尿潴留、双侧面瘫、眼肌麻痹和自主功能障碍)。[19]Petersen CL, Hemker BG, Jacobson RD, et al. Wilms tumor presenting with lambert-eaton myasthenic syndrome. J Pediatr Hematol Oncol. 2013;35:267-270.http://www.ncbi.nlm.nih.gov/pubmed/23612377?tool=bestpractice.comWilms 瘤的心脏内扩散较为罕见。[20]Abdullah Y, Karpelowsky J, Davidson A, et al. Management of nine cases of Wilms' tumour with intracardiac extension - a single centre experience. J Pediatr Surg. 2013;48:394-399.http://www.ncbi.nlm.nih.gov/pubmed/23414872?tool=bestpractice.com