Signs and Symptoms of Wilms Tumor

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1. Initial signs and symptoms, in order of frequency, are listed in Table 19-3.

2. Abdominal mass is the most common presenting symptom and sign. Occasionally, there is abdominal pain, especially when hemorrhage occurs in the tumor following trauma.

3. Hematuria is not common but is more often seen microscopically than on gross examination.

4. Hypertension is seen in approximately 25% of patients due to elaboration of renin by tumor cells or, less commonly, due to compression of renal vascu-lature.

5. Polycythemia is occasionally present. Erythropoietin levels are usually increased but can also be normal. Polycythemia is usually associated with males, older age, and low clinical stage. All children with unexplained poly-cythemia should be investigated for Wilms' tumor.

6. Bleeding diathesis is due to the presence of acquired von Willebrand disease (reduced von Willebrand factor antigen level, prolonged bleeding time, decreased factor VIII, and factor VIII ristocetin cofactor activity).

Table 19-3. Initial Signs and Symptoms of Wilms' Tumor in Order of Frequency

Sign/symptom Frequency (%)

Palpable mass in abdomen 60

Hypertension 25

Hematuria 15

Obstipation 4

Weight loss 4

Urinary tract infection 3

Diarrhea 3

Previous trauma 3

Other signs/symptoms: nausea, vomiting, abdominal pain, 8 inguinal hernia, cardiac insufficiency/ acute surgical abdomen, pleural effusion, polycythemia, hydrocephalus6

"Due to propagation of tumor clot from inferior vena cava into right atrium.

Intracerebral secondary-associated congenital anomaly or associated central nervous system tumor.

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