A 6-year-old boy presents with a painless right-sided abdominal mass discovered incidentally. CT shows a large renal mass with heterogeneous enhancement. Which of the following is the MOST common histological finding and the chemotherapy used preoperatively in the UK/European protocol?

• A Clear cell renal cell carcinoma; sunitinib
• B Wilms' tumour (nephroblastoma); actinomycin-D and vincristine (SIOP protocol) ✓
• C Neuroblastoma; cisplatin and etoposide
• D Angiomyolipoma; no chemotherapy required

Explanation

Wilms' tumour (nephroblastoma) is the most common renal malignancy in children (peak age 3-4 years). The European SIOP (International Society of Paediatric Oncology) protocol recommends pre-operative chemotherapy (actinomycin-D + vincristine for stages I-III; adding doxorubicin for higher stages) followed by nephrectomy — this approach reduces intraoperative tumour rupture risk. The North American COG protocol uses upfront nephrectomy instead. Both approaches have excellent outcomes.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.