Botryoid Wilms' tumor: a case report and review of the literature

Abstract

Here, we report a new case of botryoid Wilms' tumor, a 4-year-old boy, who was referred to us with a chief complaint of dysuria and gross hematuria. The computed tomography and radical nephroureterectomy showed that a botryoid sarcoma-like appearance occupied the right renal pelvis and extended into the bladder. Histologic examination further confirmed this case was a mixed type of Wilms' tumor. In a word, we demonstrated a rare case of botryoid Wilms' tumor, which extended from the renal pelvis into the ureter and bladder, then some degenerative and necrotic tissue with calcification discharged from urethra. Postoperative adjuvant chemotherapy was executed. At 24-month follow-up, there was no evidence of recurrence.

Figure 1

Non-contrasted CT and Contrasted enhanced CT. (A) Non-contrast CT illustrated enlarged inhomogeneous right kidney consisting of multiple water-density masses, which filled the pelvicalyceal system. (B) Contrasted-enhanced CT showed that the masses at the same level were enhanced slightly and inhomogeneously.

Figure 2

Nephrogenic phase sagittal and coronal CT. (A,B) Sagittal CT showed the botryoid tumor mass extended from the renal pelvis into the ureter and the bladder. (C,D) Coronal CT illustrated a botryoid sarcoma-like appearance.

Figure 3

Lesion characteristics under microscope. (A) Microscopically, tumor extended into the pelvis by transitional cell of the urothelium. (B) The tissue discharged from urethra illustrated degenerative and necrotic tissue with calcification.

Figure 4

Resected specimen. (A) Botryoid sarcoma-like appearance, occupied the right renal pelvicaliceal system, renal pelvis and ureter. (B) Grayish polypoid mass with coagulation necrosis.