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Vaginal metastases of Wilms’ Tumor in a pediatric patient: a rare case

  • Kristina Arion
    Correspondence
    Corresponding author. Kristina Arion, 5980 University Ave, Halifax, NS, B3K 6R8.
    Affiliations
    Dalhousie University, Department of Obstetrics and Gynecology, Halifax, Nova Scotia, Canada
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  • Stephanie Dufour
    Affiliations
    Children's Hospital of Eastern Ontario, Department of Surgery, Division of Pediatric and Adolescent Gynecology, Ottawa, Ontario, Canada
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  • Raveena Ramphal
    Affiliations
    PRecision Oncology For Young peopLE (PROFYLE) Consortium

    Department of Pediatric Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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  • Anita Villani
    Affiliations
    PRecision Oncology For Young peopLE (PROFYLE) Consortium

    Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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  • David Malkin
    Affiliations
    PRecision Oncology For Young peopLE (PROFYLE) Consortium

    Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada

    Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada

    Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
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  • Adam Shlien
    Affiliations
    PRecision Oncology For Young peopLE (PROFYLE) Consortium

    Genetics and Genome Biology Program, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada

    Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Nisha Kanwar
    Affiliations
    PRecision Oncology For Young peopLE (PROFYLE) Consortium

    Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
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  • Sarah Sawyer
    Affiliations
    PRecision Oncology For Young peopLE (PROFYLE) Consortium

    Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada

    Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
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  • Tania Dumont
    Affiliations
    Children's Hospital of Eastern Ontario, Department of Surgery, Division of Pediatric and Adolescent Gynecology, Ottawa, Ontario, Canada

    Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada

    The Ottawa Hospital, Department of Obstetrics, Gynecology and Newborn Care, Ottawa, Ontario, Canada

    University of Ottawa, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada

    The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Published:January 17, 2023DOI:https://doi.org/10.1016/j.jpag.2023.01.001

      Abstract

      Background

      : Wilms' tumor is the second most common pediatric abdominal cancer, however, it rarely involves the female reproductive tract. There are few cases reported in the literature describing uterine, ovarian, cervical and vaginal involvement.

      Case

      : We report the case of a 7-year-old girl presenting with a large renal mass with retroperitoneal nodal and lung metastases; she was diagnosed with stage 4 favorable histology Wilms’ tumor. She was treated with surgery, chemotherapy and radiation. She presented with vaginal bleeding 10 months after completing treatment; biopsy of a vaginal mass confirmed recurrence, and this was sent for molecular profiling, which did not identify an inherited cancer predisposition or targetable mutation. She was again treated with chemotherapy; examination redemonstrated a small vaginal mass, but re-biopsy of the lesion was negative for malignancy. Due to high risk of local relapse, ongoing chemotherapy and pelvic radiation ensued. End of treatment imaging and vaginoscopy showed no residual disease.

      Summary and conclusion

      : Vaginal metastases of Wilms’ tumor are very rare; this is the second reported case in the literature. Pediatric clinicians should have a strong suspicion for vaginal metastases in cancer patients presenting with vaginal bleeding especially when their pubertal development does not suggest that bleeding would be secondary to menarche. Long-term gynecologic care for these patients is paramount to reduce morbidity from chemotherapy and pelvic radiation. Fertility preservation counselling should be made early, through referral to a specialist.

      Keywords

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