Spinal cord compression in children with Wilms' tumour.
OBJECTIVE
To document the clinical, imaging and histopathological features of five children with paraplegia due to Wilms' tumour (WT), highlighting therapeutic options and patient outcome in a developing country.


METHODS
Patients with WT and paraplegia seen at the Department of Paediatric Surgery since 1984 form the study cohort. Patient demographics, duration of neurological symptoms, stage of primary tumour, therapeutic intervention and outcome were recorded. Histology of the primary tumours and paraspinal or epidural biopsies were reviewed.


RESULTS
Five patients with WT and paraplegia were identified. Imaging showed epidural masses with paraspinal disease, cord displacement and compression. Four patients have died. Of the two patients with neurological recovery, one relapsed 4 months later. Histology revealed triphasic WT with one case showing anaplasia. Paraspinal or epidural biopsies confirmed WT with post-treatment changes. Three biopsies showed lymphovascular, perineurial and intraneural tumour invasion and one showed epidural venous invasion.


CONCLUSIONS
Although rare, WT-associated spinal disease may cause permanent neurological deficit, adding considerably to the burden of disease. In developing countries where patients present late, the prognosis is poor, however surgery may provide immediate relief of compression symptoms and biopsy material. The treatment of choice will depend on the facilities available and the clinical circumstances.
Department of Anatomical Pathology, Nelson R Mandela School of Medicine, University of KwaZulu Natal, National Health Laboratory Service, Durban, South Africa.
P K
PK
Ramdial
G P
GP
Hadley
Y
Y
Sing
D015984:Causality; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009367:Neoplasm Staging; D010264:Paraplegia / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D013115:Spinal Canal / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology; D013117:Spinal Cord Compression / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy