ADENOCARCINOMA OF KIDNEY IN SEVEN-YEAR-OLD CHILD Eight-Year Follow-Up MENASHE RAHIMA, M.D. JOSHUA BARZILAY, M .D. ILANA YANAI-INBAR, M.D. JACOB K. KANETI, M.D. From the Department of Oncology, Beilinson Medical Center, Petah Tiqva, and Tel Aviv University, Sackler School of Medicine, and the Departments of Pathology and Urology, The Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel ABSTRACT-A seven-year-old child with regionally advanced adenocarcinoma of the left kidney is described. It is now eight years since surgery and irradiation, and there is no evidence of disease. Follow-up and review of the literature is presented. Adenocarcinoma accounts for almost 80 per cent of all adult kidney tumors, but is a rare disease in children under the age of fifteen. Fewer than 90 cases have been reported, and little is known regarding its prognosis and treat- ment.’ We report on a successfully treated young girl with regionally advanced adenocar- cinema of the left kidney who has been fol- lowed in our clinic for eight years. The rarity of this disease in this age group and the successful outcome of treatment led to this report. Case Report A seven-year-old girl born in Israel to parents of North African ancestry, was admitted to the hospital with a two-month history of painless hematuria unaccompanied by weight loss or fever. On examination a large, irregular, solid mass was palpated in the left flank. Urinalysis revealed microscopic hematuria, but blood counts and blood chemistries were within nor- mal limits. An intravenous pyelogram (IVP) showed blunting of the calyces in the lower pole; selective aortic angiography revealed a mass in left flank with pathologic blood vessels. At laparotomy, in January, 1974, a large tu- mor in the lower pole of the left kidney was found together with infiltration of the perirenal fat. Lymph nodes in the renal hilum and along the left para-aortic chain, from the diaphragm to the common iliac, were also involved. A rad- ical left nephrectomy was performed with re- section of the para-aortic lymph nodes. A num- ber of lymph nodes adherent to the psoas fascia were removed. Following surgery, the patient received irra- diation to the epigastrium, para-aortic chains, and the kidney bed. A total of 3,400 rad, in a fractionation dose of 200 rad in two opposed fields, was delivered. Thereafter, the patient received no further therapy and has remained in follow-up. During the eight years she has undergone repeated chest x-ray films, liver scans, urine and blood tests, all of which have been normal. Her physi- cal development, including secondary sexual characteristics, are all normal, and her only problem is a loss of lordosis in the lumbar spine due to growth defects in the vertebrae second- ary to the radiotherapy. 182 UROLOGY / AUGUST 1984 / VOLUME XXIV, NUMBER 2