A 4-year-old girl presents with a right-sided abdominal mass. CT abdomen shows a well-encapsulated renal mass with nephroblastomatous tissue. AFP and urine catecholamines are normal. What is the most likely diagnosis and the correct initial management in Europe (SIOPE/SIOP protocol)?
- A Neuroblastoma; immediate adrenalectomy
- B Wilms' tumour; neoadjuvant chemotherapy before nephrectomy ✓
- C Wilms' tumour; immediate nephrectomy without prior chemotherapy
- D Mesoblastic nephroma; observation only
Correct answer: B. Wilms' tumour; neoadjuvant chemotherapy before nephrectomy
Explanation
Wilms' tumour (nephroblastoma) is the most common renal tumour in children aged 3–5 years. The SIOP (European) protocol favours preoperative (neoadjuvant) actinomycin D + vincristine chemotherapy for 4 weeks before nephrectomy, which reduces tumour size and intraoperative rupture risk. The North American COG protocol favours upfront nephrectomy followed by chemotherapy/radiotherapy. AFP elevation suggests a yolk-sac tumour; elevated catecholamines suggest neuroblastoma.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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