A 2-year-old boy was having worsening daily episodes of explosive diarrhea. He had no fevers, and his appetite and diet were unchanged. When his mother took him to the pediatrician, an abdominal examination detected a palpable mass in the left flank. Further imaging confirmed a mass on the left kidney. Based on presenting symptoms and imaging, the tentative diagnosis of Wilms’ tumor was made. Biopsy is not typically done due to the risk of fragmentation of this delicate tumor. Surgical excision is the treatment of choice when possible, based on the staging of the tumor, its size, and involvement of associated structures. This child’s tumor was successfully resected. In such cases, the 5-year survival rate is greater than 90%.


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.


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