A Wilms Tumor Patient with Leptomeningeal Metastases, A Case Report and Literature Review of Early CNS Metastasis, At Presentation or During Treatment

Background: Wilms tumor (WT) is the most frequently occurring pediatric kidney cancer.Around 10-17% of patients with Wilms tumor present with metastatic disease, most commonly in the lungs and liver.In patients with Wilms tumor, central nervous system metastases are uncommon.This study was conducted with the aim of identifying patients with leptomeningeal metastases and their specific characteristics.Methods: An in-depth case description of a patient with a Wilms tumor who developed leptomeningeal metastases during treatment was provided.For this narrative literature review, a PubMed data search was performed up until November 8, 2023.Articles were screened based on predefined inclusion and exclusion criteria. Results:We report a three-year-old male presenting with stage IV, local stage III intermediate-risk Wilms tumor, with bone metastases and a solitary lung metastasis.Despite the initial response to treatment, the patient developed seizures during therapy, based on leptomeningeal metastases without obvious brain mass.A literature review on early central nervous system metastases in patients with Wilms tumor (at diagnosis, or during therapy) identified 10 additional patients with Wilms tumor showing central nervous system disease but did not identify any other patient with leptomeningeal disease (only).Conclusions: Leptomeningeal metastases in Wilms tumor patients are rare and may not be recognized due to a lack of available literature and awareness.However, it is crucial to remain vigilant for symptoms of leptomeningeal metastases, even in patients with an intermediate-risk histology.