A 17-month-old black male, who had bilateral Wilms tumor diagnosed nine months earlier, was presented for consideration of further therapy.
He was first seen when eight months of age because of a right-sided abdominal mass. There was no hematuria and his blood pressure was normal at that time. The past medical history was interesting. He had been a 5 Ib, 10 oz product of an eight month gestation. His mother had worked as a laboratory technician with radioactive isotopes for three months after she became pregnant, although she knew this was not permitted. She had also been treated for a positive VDRL during pregnancy. The child was treated at delivery as well. In the nursery he was noted to have hypospadias and undescended testes, and an intravenous pyelogram (IW) done at that time was said to be normal. His development was slow; he was a "floppy" baby, was unable to sit, and had a history of regurgitating his feedings.
Physical examination revealed a happy eight-month-old black infant with a protuberant abdomen. Although his weight was at the 50th%, his head circumference was at the 95th%. A large mass was palpated on the right side, with its margin distinct from that of the liver, and measuring 10 X 12 cm. On the left side a spleen tip was palpated, and a 4 X 4 cm mass was appreciated on deep palpation. The genital examination revealed partial hypospadias and bilateral undescended testes. lytes, blood urea nitrogen, and liver function tests. A vanillylmandelic acid spot test was negative. An intravenous pyelogram (IVP) was performed and was followed by a laparotomy the next day.