Giuseppe De Bernardo
1*, Angela Lucariello
2, Antonio Saggese
3, Maurizio Giordano
1, Desiree Sordino
1, Carmela Buonomo
4, Stefano Gisone
5, Antonio De Luca
5, Germano Guerra
6, Angelica Perna
6* 
1 Department of Mother’s and Child’s Health – Fondazione Poliambulanza Istituto Ospedaliero Brescia, Italy
2 Department of Sport Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
3 Institute of Legal Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
4 UOC Pathological Anatomy A.O.R.N. Sant’Anna-San Sebastiano, Caserta, Italy
5 Department of Mental Health and Preventive Medicine, section of Human Anatomy, University of Campania “L. Vanvitelli” Naples, Italy
6 Department of Medicine and Health Sciences “Vincenzo Tiberio”, University of Molise, Campobasso, Italy
Abstract
Wilms tumor (WT) occurs in 1:10.000 live births and affects mainly the unilateral kidney.
The National Wilms Tumor Study Group registered 6832 patients with WT from 1969 to
January 1993, out of whom only 11 patients (0.16%) were newborns. Since 1969, 14 cases of
prenatal diagnosis of WT have been reported in literature, two of which were bilateral WT.
Currently, the patients’ survival rate is greater than 90%, owing to a combination of surgery,
chemotherapy, and radiotherapy for high-risk patients.
We report a case of bilateral WT, undiagnosed during the prenatal period due to the incomplete
evaluation of the abdomen with ultrasonography. The newborn was vaginally delivered at
40 weeks’ gestational age with a good perinatal adaptation. Suddenly, during the night the
newborn showed respiratory distress, bradycardia and then respiratory arrest. For this
reason, he was ventilated, intubated and subjected to conventional mechanical ventilation.
Despite the normal cardiac ultrasonography, the health care providers suspected a cyanotic
congenital heart disease with duct dependency. After a gradual resumption of the oximetry
and blood pressure, the infant was transported by the neonatal emergency transport system to
the Cardiac Pediatric Surgery Department of a level III hospital. There, the clinical condition
became extremely serious and the infant died of asystole. During autopsy, two large tumoral
masses were found in both kidneys, also the characterization of the tumors was done through
histological exam, which confirmed the diagnosis of WT. A prenatal diagnosis of WT is very
important because the families can take advantage of prenatal counseling to understand the
risks of continuing the pregnancy and to evaluate the need for abortion, while health care
providers can prepare to face a difficult delivery. The review of the literature suggests that
prenatal diagnosis of bilateral WT is possible. During prenatal age, the complete assessment
of the abdomen with ultrasonography and Eco-Color-Doppler can reveal kidney anomalies
and raise suspicion of diseases with urinary malformations.
Implication for health policy/practice/research/medical education:
Diagnosis of Wilms Tumor can be obtained by fetal ultrasonography.
Please cite this paper as: De Bernardo G, Lucariello A, Saggese A, Giordano M, Sordino D, Buonomo C, et al. Bilateral
Wilms tumor with neonatal onset and the importance of prenatal diagnosis. J Renal Inj Prev. 2019;8(4):257-262. DOI: 10.15171/
jrip.2019.49.