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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Article info
Publication history
Accepted:
January 5,
2023
Received in revised form:
December 6,
2022
Received:
September 2,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology.
