Primary renal masses in children in cameroun : a plea for pre-treatment histology

ABSTRACT

Objectives To determine; if patients should receive chemotherapy on clinico-radiologic basis; without a histologic diagnosis. Patients and Methods This was a retrospective review of all cases of paediatric renal tumors collated from the pathology register at the Yaounde General Hospital and Yaounde University Teaching Hospital over a 15-year period. Clinical data and histology results were entered into an Epi-Info 5.1 database and analyzed. There were a total of 29 patients; 18 (62.1) males and 11 (37.9) females. The mean age was 6.4 years; median 5 years and the range from 1 to 20 years. Twenty-eight patients (96.6) had a palpable mass; 16 (55.2) haematuria; 8 (27.6) anaemia; 5 (17.2) weight loss; 2 (6.9) bone pain and in 1 (3.4) the renal mass was detected on ultrasound of the abdomen for suspected urinary infection. The symptom duration before presentation ranged from one to seven months with a mean of 2.5 months. Twelve patients (41.4) presented within two months. Results Twenty-seven (93.1) patients had malignancy; whereas two (6.9) had benign tumors. Twenty-one (72.4) had nephroblastomas; 4 (13.8) had lymphomas; 2 (6.9) had adenocarcinomas and one (3.4) each had mesenchymoma and angiomyo-lipoma. Survival data were available in 18 of the 27 patients with malignant tumors. Two patients with lymphoma survived more than 3 years (33.3) and one patient with papillary adenocacinoma survived 7 years (16.7). Fifteen of 21 patients (71.4) with nephro-blastoma survived past 5 years. Conclusion While nephroblastoma is the most common tumor cell type; lymphomas and adenocarcinomas occur in over 20of children with renal tumors. Therefore; prior to chemotherapy and radiotherapy; it is imperative to make a histologic diagnosis so as to determine the most suitable treatment protocol