Exploring Wilms Tumour: A Series of Four Cases

Wilms tumour, or nephroblastoma, is a common neoplasm in children, with a mean age of incidence between 2-5 years and no sex predilection. The incidence accounts for approximately 7.8 cases per million children, with bilaterality occurring in 5-10% of cases. This is a case series comprising four cases, each with a different histomorphological spectrum. Typically, Wilms tumour is a triphasic tumour comprised of blastemal, epithelial, and stromal components. This case series presents a variety of histomorphological spectra, including biphasic tumours with blastemal predominance, epithelial predominance, and stromal predominance with heterologous differentiation. These variations can aid in assessing the prognosis of the tumour. Usually, by immunohistochemistry (IHC), WT1 is positive in all Wilms tumours. However, in this case series, WT1-negative Wilms tumours are reported. Demonstrating unique cases with uncommon histological patterns and IHC markers can enhance our understanding of Wilms tumours and their management. This case series also aids in differentiating Wilms tumours from other paediatric renal tumours with similar histopathological patterns. Hereby, the authors present a case series of four children. The first case involved a one-and-a-half- year-old male child who presented with an abdominal mass that was noted incidentally in the right lumbar region after a self-fall within two weeks. The second case involved a six-year-old female child who presented with abdominal pain for one week following a fall, during which a mass was noted incidentally in the right hypochondrium upon clinical examination. The third case involved a two-year-old female child who also presented with an abdominal mass in the right hypochondrium for one month, which was discovered incidentally. The last case involved a three-year-old male child who presented with abdominal fullness for three days, and a mass was noted by the clinician in the left hypochondrium during clinical examination. All four children were diagnosed with Wilms tumour after radiological investigations and underwent 4-6 cycles of chemotherapy prior to radical nephroureterectomy. The resected specimens were received in the histopathological Department, and a diagnosis of Wilms tumour was made. An IHC panel was performed to rule out other small round blue cell tumours.