Answer: A - In pediatric patients with a painless sizeable abdominal mass that has caused malignant pleural effusion, a Wilms tumor is suspected. Abdominal and renal ultrasound will establish the size of the tumor, and whether it involves the inferior vena cava.
Over-manipulation and fine needle aspiration of a Wilms tumor is contraindicated due to the possibility of rupturing the capsule and seeding of the abdomen with tumor cells. Contrast CT can help confirm the diagnosis, establish the involvement of the inferior vena cava, and ascertain the presence of metastatic disease. MRI is indicated for cases where inferior vena cava involvement and patency is equivocal on CT, which is superior to CT for that.
Wilms' tumor is a rare kidney cancer that primarily affects children. Also known as nephroblastoma, Wilms' tumor is the most common cancer of the kidneys in children. Wilms' tumor most often affects children ages 3 to 4 and becomes much less common after age 5.
Wilms' tumor most often occurs in just one kidney, though it can sometimes be found in both kidneys simultaneously.
Sources: Mayo Clinic
