Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour
Introduction: Renal artery embolization has been used in a palliative fashion for symptomatic relief of hematuria or flank pain in unresectable renal cell carcinoma in adults. There is limited data on using embolization for actively bleeding and unresectable tumours in the oncological pediatric pop...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Shaukat Khanum Memorial Trust
2023-12-01
|
| Series: | Journal of Cancer and Allied Specialties |
| Subjects: | |
| Online Access: | https://journals.sfu.ca/jcas/index.php/jcas/article/view/603 |
| _version_ | 1797348032243564544 |
|---|---|
| author | Areej Salim Sajid Ali Muhammad Ali Sheikh Tariq Latif Islah Ud Din |
| author_facet | Areej Salim Sajid Ali Muhammad Ali Sheikh Tariq Latif Islah Ud Din |
| author_sort | Areej Salim |
| collection | DOAJ |
| description |
Introduction: Renal artery embolization has been used in a palliative fashion for symptomatic relief of hematuria or flank pain in unresectable renal cell carcinoma in adults. There is limited data on using embolization for actively bleeding and unresectable tumours in the oncological pediatric population. Case description: A previously healthy, five-year-old boy with no significant past medical or surgical history presented to the clinic with gradually worsening abdominal distension associated with occasional abdominal pain, gross hematuria, and lethargy for four months. Diagnostic investigations showed an 18 cm left-sided metastatic (pulmonary) renal tumour (Wilms), which was deemed unresectable on imaging. Treatment was planned on SIOP-RTSG protocol. However, he became hemodynamically and vitally unstable with acute sudden distension of the abdomen on the left side after the first cycle of chemotherapy. Imaging showed active bleeding from an inferior branch of the left renal artery. Selective angioembolization was done, and chemotherapy was reinitiated with a patent left main renal artery. Following the fourth cycle of chemotherapy, he developed hemodynamic instability and abdominal pain; imaging revealed the resolution of pulmonary nodules and bleeding from the left renal artery (main); this was again embolized, and the patient was stabilized. The patient was operated on after optimization and complete resection of the mass was done with negative margins. On six months follow up, he is well. Practical implications: To the best of our knowledge, this is the first case where angioembolization has been done in conjunction with neoadjuvant chemotherapy to downsize a Wilms Tumor to achieve favourable outcomes. Continued research efforts are necessary to optimize strategies and improve the prognosis for pediatric patients, and this case is one of the prime examples.
|
| first_indexed | 2024-03-08T11:57:34Z |
| format | Article |
| id | doaj.art-74d3addb6df84a2582b5a8d1b099e04c |
| institution | Directory Open Access Journal |
| issn | 2411-989X |
| language | English |
| last_indexed | 2024-03-08T11:57:34Z |
| publishDate | 2023-12-01 |
| publisher | Shaukat Khanum Memorial Trust |
| record_format | Article |
| series | Journal of Cancer and Allied Specialties |
| spelling | doaj.art-74d3addb6df84a2582b5a8d1b099e04c2024-01-24T00:15:02ZengShaukat Khanum Memorial TrustJournal of Cancer and Allied Specialties2411-989X2023-12-0110110.37029/jcas.v10i1.603Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour Areej Salim0Sajid Ali1Muhammad Ali Sheikh2Tariq Latif3Islah Ud Din4Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan Introduction: Renal artery embolization has been used in a palliative fashion for symptomatic relief of hematuria or flank pain in unresectable renal cell carcinoma in adults. There is limited data on using embolization for actively bleeding and unresectable tumours in the oncological pediatric population. Case description: A previously healthy, five-year-old boy with no significant past medical or surgical history presented to the clinic with gradually worsening abdominal distension associated with occasional abdominal pain, gross hematuria, and lethargy for four months. Diagnostic investigations showed an 18 cm left-sided metastatic (pulmonary) renal tumour (Wilms), which was deemed unresectable on imaging. Treatment was planned on SIOP-RTSG protocol. However, he became hemodynamically and vitally unstable with acute sudden distension of the abdomen on the left side after the first cycle of chemotherapy. Imaging showed active bleeding from an inferior branch of the left renal artery. Selective angioembolization was done, and chemotherapy was reinitiated with a patent left main renal artery. Following the fourth cycle of chemotherapy, he developed hemodynamic instability and abdominal pain; imaging revealed the resolution of pulmonary nodules and bleeding from the left renal artery (main); this was again embolized, and the patient was stabilized. The patient was operated on after optimization and complete resection of the mass was done with negative margins. On six months follow up, he is well. Practical implications: To the best of our knowledge, this is the first case where angioembolization has been done in conjunction with neoadjuvant chemotherapy to downsize a Wilms Tumor to achieve favourable outcomes. Continued research efforts are necessary to optimize strategies and improve the prognosis for pediatric patients, and this case is one of the prime examples. https://journals.sfu.ca/jcas/index.php/jcas/article/view/603Angioembolizationhemorrhagic tumourIntervention RadiologyPaediatric surgeryWilms tumour |
| spellingShingle | Areej Salim Sajid Ali Muhammad Ali Sheikh Tariq Latif Islah Ud Din Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour Journal of Cancer and Allied Specialties Angioembolization hemorrhagic tumour Intervention Radiology Paediatric surgery Wilms tumour |
| title | Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour |
| title_full | Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour |
| title_fullStr | Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour |
| title_full_unstemmed | Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour |
| title_short | Emergency Angioembolization for Life-Threatening Haemorrhage in Wilms Tumour |
| title_sort | emergency angioembolization for life threatening haemorrhage in wilms tumour |
| topic | Angioembolization hemorrhagic tumour Intervention Radiology Paediatric surgery Wilms tumour |
| url | https://journals.sfu.ca/jcas/index.php/jcas/article/view/603 |
| work_keys_str_mv | AT areejsalim emergencyangioembolizationforlifethreateninghaemorrhageinwilmstumour AT sajidali emergencyangioembolizationforlifethreateninghaemorrhageinwilmstumour AT muhammadalisheikh emergencyangioembolizationforlifethreateninghaemorrhageinwilmstumour AT tariqlatif emergencyangioembolizationforlifethreateninghaemorrhageinwilmstumour AT islahuddin emergencyangioembolizationforlifethreateninghaemorrhageinwilmstumour |