Wilms tumor vs Neuroblastoma and hepatoblastoma
How to tell Wilms tumor and Neuroblastoma and hepatoblastoma apart when a board question makes them look alike.
Wilms is kidney mass; neuroblastoma is adrenal/sympathetic catecholamine tumor; hepatoblastoma is AFP liver tumor.
Side by side
Wilms tumor is a pediatric renal tumor age 2-5 with painless abdominal mass, hematuria or hypertension, WT1/WT2 association, and links to WAGR, Denys-Drash, and Beckwith-Wiedemann.
Neuroblastoma arises from adrenal or sympathetic chain, often under age 2, with elevated HVA/VMA, N-myc poor prognosis, opsoclonus-myoclonus, and metastatic orbital ecchymoses; hepatoblastoma is liver tumor with high AFP.
Wilms tumor is renal tumor with painless abdominal mass, hematuria/hypertension, WT1 association, and favorable pediatric kidney cancer pattern.
Neuroblastoma arises from adrenal/sympathetic chain with catecholamines, opsoclonus-myoclonus, raccoon eyes; hepatoblastoma is liver tumor with elevated AFP.
Wilms: WT1/WT2, abdominal mass, hematuria/hypertension, WAGR/Denys-Drash/Beckwith-Wiedemann associations.
Neuroblastoma: HVA/VMA, N-myc amplification, adrenal/sympathetic mass, opsoclonus-myoclonus, raccoon eyes from metastases. Hepatoblastoma: elevated AFP.
The repair move
Before naming the answer, force the stem through the separator: Wilms is kidney mass; neuroblastoma is adrenal/sympathetic catecholamine tumor; hepatoblastoma is AFP liver tumor.
Try a free question
CoreA 3-year-old child with a history of congenital aniridia is found by his pediatrician to have a smooth, firm, non-tender abdominal mass on routine examination. Vital signs show hypertension. Renal ultrasound shows a solid mass arising from the right kidney. Which pediatric malignancy is most likely?
Show answer and explanation
Answer: A. Wilms tumor (nephroblastoma). Wilms tumor (nephroblastoma) is the most common pediatric renal tumor, peak age 2-5 years. Presents with painless abdominal mass, hematuria, hypertension. WT1 gene (chromosome 11p13) associated with WAGR syndrome (Wilms, Aniridia, GU anomalies, intellectual disability) and Denys-Drash syndrome. WT2 (11p15) associated with Beckwith-Wiedemann syndrome (overgrowth, macroglossia, omphalocele, hemihypertrophy). Treat with nephrectomy plus chemotherapy and radiation depending on stage/histology.
Why the other choices are tempting
- B. Neuroblastoma arises from adrenal medulla or sympathetic chain, not kidney; classically <2 years.
- C. Hepatoblastoma is a liver tumor with markedly elevated AFP.
- D. Renal cell carcinoma is a tumor of older adults.
- E. Bladder rhabdomyosarcoma is in the bladder, not the renal parenchyma.
Flashcards
Tap a card to flip it.
What clue supports Wilms tumor?
Choose Wilms tumor when the stem gives this pattern: Wilms tumor is renal tumor with painless abdominal mass, hematuria/hypertension, WT1 association, and favorable pediatric kidney cancer pattern.
What clue supports Neuroblastoma and hepatoblastoma?
Choose Neuroblastoma and hepatoblastoma when the stem gives this contrasting pattern: Neuroblastoma arises from adrenal/sympathetic chain with catecholamines, opsoclonus-myoclonus, raccoon eyes; hepatoblastoma is liver tumor with elevated AFP.
Quick answers
What is the fastest way to tell Wilms tumor from Neuroblastoma and hepatoblastoma?
Wilms is kidney mass; neuroblastoma is adrenal/sympathetic catecholamine tumor; hepatoblastoma is AFP liver tumor.
What is the key clue for Wilms tumor?
Wilms tumor is a pediatric renal tumor age 2-5 with painless abdominal mass, hematuria or hypertension, WT1/WT2 association, and links to WAGR, Denys-Drash, and Beckwith-Wiedemann.
What is the key clue for Neuroblastoma and hepatoblastoma?
Neuroblastoma arises from adrenal or sympathetic chain, often under age 2, with elevated HVA/VMA, N-myc poor prognosis, opsoclonus-myoclonus, and metastatic orbital ecchymoses; hepatoblastoma is liver tumor with high AFP.