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We report a case of a pediatric Wilms' tumor presenting after a right renal injury. A 6-year-old girl presented to a nearby hospital with right back pain after a fall. An abdominal computed tomography (CT) scan revealed a right renal injury with active hemorrhaging. She was then referred to our hospital. There another CT scan and a magnetic resonance imaging (MRI) scan revealed the disappearance of the active hemorrhaging but also the presence of a large renal tumor. We performed a right nephrectomy. The renal tumor was diagnosed as a nephroblastoma. Considering dissemination by trauma, chemotherapy and radiation therapy were performed.

A 33-year-old woman was referred to our hospital for further examination of a right adrenal mass 4.5 cm in diameter. Hormonal findings were normal. Computed tomography, magnetic resonance image and angiograpy demonstrated non-functioning adrenal tumor. Right nephrectomy was performed, because the tumor adhered firmly to the upper pole of the right kidney. The pathological diagnosis was nephroblastoma (nephroblastic type, complex subtype). Postoperative chemotherapy was started for stage III Wilms' tumor. However, peripheral neuropathy such as numbness of the fingers developed. Therefore, chemotherapy was discontinued in the fifth week. The patient is currently alive without recurrence 17 months postoperatively. In adult patients, postoperative chemotherapy for nephroblastoma is often interrupted due to side effects. Further studies on the protocol for adults is necessary.

Wilms tumor has an excellent prognosis according to the findings of the National Wilms Tumor Study (NWTS). The NWTS has been aiming to reduce the intensity of treatment for low-risk groups. Pathologic assessment or statistical analysis has identified the appropriate staging system suited to this treatment regimen. The Japanese Wilms Tumor Study (JWiTS) has been following the NWTS-5 regimen to increase survival rates and tumor-free survival rates from 1996. This study aims to establish a central review system of pathology and to study the presence of WT1 mutation in tumor samples. In addition, JWiTS focuses on developing an online database that can be shared over the Internet. However, the prognosis in patients with malignant rhabdoid tumor of the kidney (MRTK) is still poor. JWiTS has started to consider a new regimen for MRTK.

Wilms' tumor is very rarely found in adults and there are no established treatment guidelines for such tumors in adults. A 56-year-old woman was referred to our hospital for further examination of macroscopic hematuria. Computed tomography scan revealed a large right renal mass with enlarged lymph nodes. Angiography showed a hypovascular tumor. She underwent right nephrectomy and resection of lymph node metastasis with a diagnosis of malignant renal tumor. Histopathological examination revealed nephroblastoma with lymph node metastasis. The disease was classified as stage III according to the National Wilms' Tumor Study classification. The patient received adjuvant chemotherapy consisting of ifosfamide, cisplatin, and etoposide. This protocol was selected because of the published poor results with the standard Wilms' tumor chemotherapeutic agents when used in adults. She remained without tumor recurrence as of six months after surgery. Development of better therapeutic approaches to adult Wilms' tumor is awaited.

We treated a rare case of adult mesoblastic nephroma. The patient was a 52-year-old Japanese man with the chief complaint of intermittent gross hematuria and left lumbar pain. Abdominal ultrasonography, computed tomography, excretory urography, retrograde pyelography and angiography revealed a left renal tumor suspected to be a left pelvic tumor. A left nephroureterectomy was performed. The histologic examination showed a mesoblastic nephroma. A total of 38 adult mesoblastic nephroma cases were reviewed.

We present a case report of adult Wilms' tumor and reviewed from 1981. A 22-year-old woman with chief complaints of gross hematuria and right backache was introduced to our hospital in March 1998. Abdominal computed tomography (CT) revealed a solitary irregular mass (5.0 cm) at the lower pole of right kidney with no contrast medium enhancement. Angiography showed a hypovascular character, but irregular vascularization was found in the tumor. We performed a radical nephrectomy with a preoperative diagnosis of malignant renal tumor. Finally, adult Wilms' tumor (epithelial type) was diagnosed by pathological examination. We retrospectively studied the clinical and radiological features in 16 reported cases of adult Wilms' tumor from 1981. The average age was distinctly younger than that of renal cell carcinoma. Nearly half of the cases were at an advanced clinical stage (direct invasion or metastasis to other organs) at first consultation. Radiologically, Wilms' tumor tends to be visualized as a low density mass in the precontrast CT scan (75.0%) and hypovascular tumor by selective angiography (84.6%). Although this is not a definitive character to distinguish adult Wilms' tumor from renal cell carcinoma, it may be useful information for differential diagnosis.

Recent advances in the diagnosis and treatment of Wilms' tumor are reviewed. Our study disclosed that principal clinical and pathological features of Wilms' tumor are as follows: (1) It occurs in young infants and children under 5 years of age; (2) It is frequently associated with other congenital anomalies; (3) Deletion of a portion of short arm of chromosome 11 can be closely related to the tumor genesis of nephroblastoma; (4) The occurrence of distant metastases is rare at diagnosis; (5) Differential diagnosis between Wilms' tumor and neuroblastoma is occasionally quite difficult; (6) There is no good tumor marker specific to Wilms' tumor; and (7) Two-year survival rate is about 90% at present.

A case of Wilms' tumor in an adult patient is presented. The tumor in adults is rather rare and has an unfavorable prognosis. A 39-year-old man bruised his left flank while skiing in February, 1983. He noticed severe left flank pain. The pain subsided after a week of rest. However, he complained of left abdominal mass and dull pain again, and consulted our outpatient clinic on May 21, 1983. Left transperitoneal nephrectomy was performed under a diagnosis of left injured renal tumor. Histological diagnosis was nephroblastoma. A combined chemotherapy of actinomycin D (ACD) and vincristine (VCR) was started after operation. A total of 10 mg of ACD and 14 mg of VCR was administered by the end of 1983. In March 1984, however, a local recurrence and pulmonary metastases of the tumor were detected by CT and chest films. Local RF-hyperthermia combined with irradiation, alpha-interferon or chemotherapy using cisplatin and adriamycin was given. The patient died of profound cachexia in December, 1984 after gradual deterioration of general conditions.

A simple method for obtaining high-resolution banding patterns on elongated chromosomes is devised as follows: Peripheral lymphocytes cultured for 3 days with phytohemagglutinin were exposed to 10 micrograms/ml ethidium bromide for 2 hours and with 0.02 micrograms/ml colcemid for 1 hour prior to harvesting. After preparation by steam-dry method, high-resolution G-bands were obtained by Giemsa staining following exposure to hydrogen peroxide and trypsin treatment. 19 cases of the Prader-Willi syndrome, 3 cases of the aniridia-Wilms' tumor syndrome, 2 cases of the Langer-Giedion syndrome, 2 cases of retinoblastoma and 6 cases with multiple congenital anomalies whose diagnosis was not made by routine chromosome analysis were examined by this method. 18 of the 19 cases of the Prader-Willi syndrome had a deletion of 15q11.2. 2 of the 3 cases of the aniridia-Wilms' tumor syndrome had a deletion of 11p13 and the other had a balanced insertion with a breakpoint at 11p13. The 2 cases of the Langer-Giedion syndrome had a deletion of 8q23.3-24.13. One of retinoblastoma had a deletion of 13q14 and the other had a balanced reciprocal X/13 translocation with breakpoints at Xp11.21 and 13q12.3. The last 6 cases had subtle chromosomal aberrations: 46, XX, del (5) (q15q22), 46, XX, del (13) (q32.3), 46, XX, inv dup (6) (p25p21.3), 46, XX, -5, +der (5), t (3; 5) (p23; p13) mat, 46, XX, -5, +der (5), t (5; 9) (p13.3p21) mat, and 46, XX, -4, +der (4), t (4; 16) (p15.2; p13.1) pat. The simple method for high-resolution banding of chromosomes is useful for diagnosis of many kinds of birth defects.

We experienced six rare cases of solid renal tumor, which include two benign (CMN, MLCN) and four malignant tumors (CCSK 2, MRTK2). CMN is the most common benign solid tumor in the neonate. MLCN has typical US or CT findings manifested by multilocular cysts and thick wall septa. CCSK and MRTK are rare malignant neoplasms, which present characteristic clinical findings such as bone metastasis or intracranial metastasis. It is important for the radiologist to understand those characteristic clinical presentation of these tumors, because differential diagnosis is often impossible just on the basis of imaging.

Multilocular cystic nephroma is an uncommon and usually benign nephroblastic neoplasm. Considering its therapeutic indication, it is important to distinguish this lesion from malignant renal masses. The lesion usually shows a well-encapsulated, multilocular cystic mass on US and CT. Occasionally, imaging studies are not useful for preoperative diagnosis, however, surgical biopsy should be considered for correct pathological diagnosis.

A case of giant renal hamartoma considered as congenital mesoblastic nephroma in an adult is reported. A 24-year-old woman was admitted to our hospital with complaints of macroscopic hematuria and left flank pain. On clinical examination, a large left renal tumor was recognized and radical left nephrectomy was performed. The tumor weighed 2,500 g. On histological examination, the tumor was composed of spindle-shaped cells, that were considered as fibroblasts, surrounded by abundant collagenous interstitial material, and many cystic or tubular structures lined by cuboidal epithelium were also seen in the peripheral region. Because of histological similarity we considered this tumor as congenital mesoblastic nephroma in an adult.

A 52-year-old, healthy looking woman was referred for further evaluation of left renal mass, She had had a history of hematuria for ten years. Admission laboratory studies were within normal limits except for slight elevation of white blood cell count, c-reactive protein, blood sedimentation rate and immunosuppressive acidic protein. Retrograde pyelography demonstrated a large mass with ringed calcification in the middle lobe of the left kidney. The multiloculated mass was also confirmed by computed tomography and ultrasonography. Selective left renal arteriography showed stretched arteries and irregularity and tortuosity of the smaller vessels. Under a presumptive diagnosis of multilocular cystic nephroma or renal cell carcinoma, left radical nephrectomy was performed. In surgical specimen, many lobules were filled with serous fluid and clotted blood. Microscopic examination revealed that the lining of the cyst wall consisted of renal cell carcinoma cell. At present, 5 months after the operation, she is well without any signs or symptoms of recurrence.

Ultrasonography is very useful and suitable for evaluating abdominal masses especially in infants and children, because it is a noninvasive, painless method and does not utilize ionizing radiation. Since 1962 we have examined various abdominal diseases in the pediatric field using ultrasonic machines with A-mode, bistable and gray scale contact compound scanners. Currently, it has become much easier to find very small lesions in the abdomen with a real time B-scanner. Hepatocarcinoma, choledochal cyst, neuroblastoma, ovarian teratoma, Wilm's tumor and hydronephroureter were presented and their echographic features were discussed. Pediatric abdominal ultrasonography is a very important modality for making accurate and quick decisions in the treatment of diseased infants and children.

A total of 452 cases of childhood malignant solid tumors were treated over the last twenty years at the National Children's Hospital. These included 175 cases of neuroblastoma, 64 cases of Wilms' tumor, 65 cases of malignant lymphoma, 45 cases of soft tissue sarcoma, 31 cases of hepatoma, 20 cases of malignant teratoma, 17 cases of testicular tumor, 7 cases of ovarian tumor and 28 cases of other forms of malignant solid tumor. Bone metastasis was observed in 62 of 175 cases of neuroblastoma, 3 of 64 cases of Wilms' tumor, one of 65 cases of malignant lymphoma, 4 of 45 cases of soft tissue sarcoma, one case of pulmonary blastoma and one case of osteogenic sarcoma, giving a total occurrence of bone metastasis in 72 of the 452 cases. The main sites of bone metastasis in neuroblastoma were the skull (61.4%), femur (56.8%), orbit (27.3%) and spine (22.7%). The average values of serum calcium and alkaline phosphatase activity showed no significant difference. The patients with bone metastasis were treated with a combination of radiation therapy and intensive chemotherapy, resulting in temporary improvement. The survival of patients with stage IV neuroblastoma with bone metastasis was worse than that of similar patients without bone metastasis.