title: A case of mixed adult Wilms' tumour and angiosarcoma responsive to carboplatin, etoposide and vincristine (CEO).
abstract: Here we report an unusual case of mixed Wilms' tumour and angiosarcoma in a 38-year-old female patient who presented with haematuria and right lower back pain. A computed tomographic (CT) scan confirmed a massive renal tumour associated with extensive retroperitoneal lymph node involvement, bony metastases and a right hip fracture. She was initially managed with palliative nephrectomy, which was followed by rapid postoperative deterioration. Histopathology revealed differentiated adult Wilms' tumour with renal angiosarcoma, whereas the pathology of the para-aortic lymph node and bone metastasis revealed angiosarcoma only. In view of her cachexia and cytopaenia, emergency chemotherapy was initiated using a modified regimen of carboplatin, etoposide and vincristine (CEO) in preference to the more traditional but less well-tolerated VAC (vincristine, actinomycin D, cyclophosphamide). Four cycles of this protocol yielded a dramatic response on re-staging CT scan. This case suggests that highly angiogenic tumours such as angiosarcoma may be effectively palliated using agents usually reserved for refractory Wilms' tumour, and supports the view that adult Wilms' tumour is more sensitive to such agents.
authors.affiliation: Division of Haematology/Oncology, University Department of Medicine, Room 405, Professorial Block, Queen Mary Hospital, Pokfulam Rd, Pokfulam, Hong Kong. the@netvigator.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Yau
authors.forename: C H
authors.initials: CH
authors.lastname: Leong
authors.forename: W K
authors.initials: WK
authors.lastname: Chan
authors.forename: J K
authors.initials: JK
authors.lastname: Chan
authors.forename: R H S
authors.initials: RH
authors.lastname: Liang
authors.forename: R J
authors.initials: RJ
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D006394:Hemangiosarcoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D010976:Platelet Count; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000008:administration & dosage; D009396:Wilms Tumor / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000970:Antineoplastic Agents; D000972:Antineoplastic Agents, Phytogenic; D014750:Vincristine; D005047:Etoposide; D016190:Carboplatin