title: Wilms tumor presenting with abdominal pain: a special subgroup of patients.
abstract: BACKGROUND
  Although significant progress has been made in the management of children with Wilms tumor, two major controversies still exist: the extent of radiographic evaluation necessary before surgery and the role of preoperative chemotherapy. This study sought to determine whether patients with Wilms tumor who presented with abdominal pain defined a special subset of patients who might require a more extensive preoperative work-up and neoadjuvant chemotherapy.
  
  
  METHODS
  From 1970 to 1995, 250 children were treated for Wilms tumor at a single pediatric institution. A retrospective chart review determined presenting signs and symptoms for each patient.
  
  
  RESULTS
  Thirty-four (14%) patients (mean age 5.5 years) sought medical attention with a chief complaint of abdominal pain. The stage distribution for these patients tended to be higher and was significantly different (P <.001, chi(2)-analysis) from those presenting without pain. Four (14%) of 29 patients with tumor available for analysis were found to have anaplastic histology.
  
  
  CONCLUSIONS
  These data suggest that patients with Wilms tumor who present with abdominal pain represent a special subgroup that tends to be older and has an increased incidence of tumor rupture, anaplasia, and higher stage. These patients may benefit from a more extensive preoperative evaluation and consideration of neoadjuvant chemotherapy.
authors.affiliation: Department of Surgery, Children's Hospital of Philadelphia, Pennsylvania, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Davidoff
authors.forename: A D
authors.initials: AD
authors.lastname: Soutter
authors.forename: S J
authors.initials: SJ
authors.lastname: Shochat
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D017677:Age Distribution; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D009396:Wilms Tumor / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000601:surgery