A 3-year-old girl is found to have a large, smooth, firm left loin mass detected incidentally while bathing. She is well with normal blood pressure. Ultrasound shows an intrarenal mass arising from the upper pole with preserved renal contour. Which management principle applies?

• A Repeated vigorous palpation helps assess resectability
• B Biopsy of the mass before any treatment confirms the diagnosis safely
• C Neoadjuvant chemotherapy can shrink the mass and facilitate nephron-sparing consideration ✓
• D Radical nephrectomy is avoided until metastatic disease is excluded

Explanation

Wilms tumour classically presents as an asymptomatic smooth loin mass in a young child. Vigorous repeated palpation is avoided because of the risk of capsular rupture and peritoneal seeding. Percutaneous biopsy risks upstaging and is generally not performed when imaging is typical. In many protocols, neoadjuvant chemotherapy shrinks the tumour, permitting safer surgery and even nephron-sparing excision in selected bilateral or favourable cases.

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

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Written and medically reviewed by the StethoPrep medical team.