Case #5 -- A 4-Year-Old Boy With an Abdominal Mass

A Mironescu, MD, AB Walker, MD


May 12, 2003


A 4-year-old boy presented with a left abdominal mass noted by his caregiver. This patient had a left undescended testicle repaired at 2 years of age and a clinically normal right testicle. His growth and development were normal. There was no significant family history of neoplasia.

Vital signs: oral temperature 98.7° F, pulse 82, respiratory rate 22/min, blood pressure 98/60 mm Hg. The patient was alert, and the neurologic examination was normal. The cardiovascular examination was also normal. No hepatomegaly was noted, but an abdominal mass was localized to the patient's left flank. No cervical, axillary, or inguinal lymphadenopathy was present.

He had a normal complete blood count (CBC) and urinalysis. His chest x-ray was also normal. An intravenous pyelogram demonstrated a normal right kidney and a left kidney almost completely replaced by a 15-cm mass.

The patient underwent an exploratory laparotomy. The findings during this procedure included an encapsulated 10 cm by 15 cm mass, with a thin rim of normal renal tissue at the hilium of the left kidney (Figures 1 and 2). No peri-aortic nodes were palpable, and the right kidney was normal. The diagnosis was confirmed by histologic findings.

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