Catastrophic intracerebral hemorrhage in a young infant with Wilms tumor.
We present a 7-month-old male infant with stage I Wilms tumor who unexpectedly died from a catastrophic intracerebral hemorrhage, 4 months after completion of chemotherapy and complete surgical resection of the tumor. The precise etiology underlying the fatal event remains unclear as postmortem was refused, but we postulate spontaneous hemorrhage from an underlying cerebral vascular malformation as the most likely cause, which led to the child's unfortunate demise. Although extremely rare, cerebral vascular anomalies have previously been reported in children with Wilms tumor. The coexistence of the 2 uncommon disorders may be related to their congenital origin. Wilms tumor diagnosed in very young infants have clinical and morphologic attributes that do not pertain in older children and the risk of associated congenital anomalies is also much higher among those discovered in the first year of life. This raises the question whether routine magnetic resonance imaging should not be performed in infants less than a year with Wilms tumor, as part of the initial evaluation, to exclude cerebral metastases and underlying vascular malformations.
van Toorn
Ronald
R
Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's hospital, Tygerberg, South Africa. vtoorn@sun.ac.za
Wessels
Glynn
G
Stefan
Christina
C
D003131:Combined Modality Therapy; D017809:Fatal Outcome; D006801:Humans; D007223:Infant; D020300:Intracranial Hemorrhages / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007680:Kidney Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods; D009396:Wilms Tumor / Q000150:complications* / Q000175:diagnosis / Q000628:therapy