Implications of an Underlying Beckwith-Wiedemann Syndrome for Wilms Tumor Treatment Strategies

Abstract

Beckwith-Wiedemann Syndrome (BWS) is a pediatric overgrowth disorder involving a predisposition to embryonal tumors. Most of the tumors associated with BWS occur in the first 8-10 years of life, and the most common is Wilms tumor (WT). BWS clinical heterogeneity includes subtle overgrowth features or even silent phenotypes, and WT may be the presenting symptom of BWS. WT in BWS individuals exhibit distinct characteristics from those of sporadic WT, and the management of these patients needs a peculiar approach. The most important feature is a higher risk of developing bilateral disease at some time in the course of the illness (synchronous bilateral disease at diagnosis or metachronous recurrence after initial presentation with unilateral disease). Accordingly, neoadjuvant chemotherapy is the recommended approach also for BWS patients with unilateral WT to facilitate nephron-sparing surgical approaches. This review emphasizes the importance of early BWS recognition, particularly if a WT has already occurred, as this will result in an urgent consideration of first-line cancer therapy.

Keywords: Beckwith–Wiedemann syndrome; Wilms tumor; nephron-sparing surgery.

Figure 1

Decision tree for cancer genetics referral. * Macroglossia, lateralized overgrowth, macrosomia, macrocephaly, tall stature. ** aniridia, genitourinary abnormalities, nephropathy, cardiac malformations, ear anomalies, abdominal wall defects, polyhydramnios, dysmorphic facial features, café au lait spots, nevus flammeus, axillary/inguinal freckling. CPS: cancer predisposition syndrome [Adapted from [7,16,17]].

Figure 2

Graphical representation of the frequency of WT in patients with BWS and of BWS in patients with WT. (A) Frequency of the occurrence of WT and other tumors in patients with a BWS diagnosis [9]. (B) Frequency of BWS and other predisposing syndromes in patients diagnosed with WT [7].