Conservative management of hyperplastic and multicentric nephroblastomatosis.
OBJECTIVE
The treatment of hyperplastic nephroblastomatosis remains controversial. We report the advantages of conservative management of hyperplastic and multicentric nephroblastomatosis associated with unilateral Wilms tumor (WT).


METHODS
During the last 10 years 48 children with unilateral WT were consecutively treated at our 2 institutions. Children with multiple solid renal masses on imaging were treated with 2-drug chemotherapy until disappearance of the lesions. Stabilization or progression of the lesions despite chemotherapy, as well as heterogeneity of the lesions on imaging, prompted nephron sparing surgery (NSS).


RESULTS
Three female infants (12, 13 and 20 months old, respectively) presented with multiple solid renal tumors at imaging. Despite chemotherapy, small and unilateral WT developed in 2 cases of hyperplastic nephroblastomatosis, which was excised. One of these infants subsequently presented with a small contralateral metachronous WT, which was excised. Both infants are disease-free with 2 normal kidneys at followup of 6 and 2 years, respectively. The third infant, who presented with unilateral multicentric WT and unilateral hyperplastic nephroblastomatosis nodules, was successfully treated with preoperative chemotherapy and enucleation of 5 tumors. Subsequently, nephrectomy was performed at another institution because the abnormal kidney outline due to NSS was misinterpreted as a recurrence of WT. She was lost to followup.


CONCLUSIONS
Hyperplastic and multicentric nephroblastomatosis is not a rare lesion and is most often associated, either initially or subsequently, with WT. In some infants with multiple solid renal masses on imaging chemotherapy and for developing WT NSS may safely allow maximum sparing of the parenchyma of both kidneys.
Pediatric Surgery Unit, Department of Experimental Medicine and Pathology, University of Rome La Sapienza, Rome, Italy.
Francesco
F
Cozzi
Amalia
A
Schiavetti
Denis A
DA
Cozzi
Francesco
F
Morini
Stefania
S
Uccini
Paolo
P
Pierani
Ascanio
A
Martino
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006965:Hyperplasia; D007223:Infant; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000628:therapy*; D009392:Nephrectomy; D009396:Wilms Tumor / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*