Patterns of Presentation, Histopathology, and Outcomes of Wilms Tumor in Children: Experience from a Tertiary Care Hospital
Background: Wilms tumor is the most common malignant renal neoplasm in childhood and remains a major contributor to pediatric cancer morbidity and mortality, particularly in low- and middle-income countries where delayed diagnosis and treatment abandonment continue to affect outcomes. Despite substantial improvements in multimodal therapy, variations in clinical presentation, histopathological characteristics, and survival outcomes remain evident across different healthcare settings.
Objective: To evaluate the patterns of clinical presentation, histopathological characteristics, treatment outcomes, and factors associated with prognosis among children diagnosed with Wilms tumor at a tertiary care hospital.
Methods: A prospective observational study was conducted among 120 pediatric patients diagnosed with Wilms tumor. Clinical characteristics, radiological findings, histopathological patterns, tumor staging, treatment modalities, and outcomes were analyzed. Histopathological classification was performed according to the International Society of Pediatric Oncology criteria. Statistical analysis was performed using SPSS version 26. Continuous variables were expressed as mean ± standard deviation, while categorical variables were expressed as frequencies and percentages. Associations between clinicopathological variables and outcomes were assessed using chi-square and independent t-tests.
Results: The mean age at diagnosis was 4.8 ± 2.1 years, with a male predominance (56.7%). Abdominal mass was the most common presenting symptom (78.3%), followed by abdominal pain (45.8%), hematuria (18.3%), and hypertension (15.8%). Favorable histology was identified in 82.5% of patients, whereas anaplastic histology was observed in 17.5%. Stage III disease constituted the largest proportion (35.8%), followed by Stage II (30.0%), Stage IV (18.3%), Stage I (12.5%), and Stage V (3.4%). Overall survival was 88.3%, while event-free survival reached 84.2%. Advanced stage disease and unfavorable histology demonstrated significant associations with mortality and recurrence (p<0.001).
Conclusion: Wilms tumor predominantly presents as an abdominal mass in early childhood. Favorable histology remains the most common subtype and is associated with improved survival. Early diagnosis, risk-adapted treatment, and multidisciplinary management significantly improve outcomes. The findings highlight the importance of prompt referral and optimized oncologic care pathways in tertiary healthcare settings.
Keywords: Wilms Tumor, Histopathology, Pediatric Oncology
