SUCCESSFUL TREATMENT OF A LOCAL RELAPSE I N AN INFANT WITH CONGENITALMESOBLASTIC NEPHROMA

A 3 1/2 month old girl was found to have a large abdominal tumor origi nating in the upper pole of the right kidney. At laparotomy the tumor had infiltrated the perirenal fat, the right lobe of the liver and the diaphragm. Partial nephrectomy was performed and the tumor was comple tely resected. However, an adequate safety margin could not be achieve d. Histology showed a congenital mesoblastic nephroma of the cellular subtype. Postoperatively no chemotherapy was considered necessary. 11 months after diagnosis the patient had an extensive local recurrence w ith infiltration of the perirenal fat, mesenterium and colon. Complete resection could not be achieved and the tumor was classified as stage III. There was a striking morphological change from spindle cells in the initial tumor to malignant round cells in the relapse specimen. Th e patient was treated with Vincristine, Actinomycin-D and Adriblastin. Radiotherapy was not given. 38 months after relapse the patient is fr ee of disease and developing normally. Our patient obviously had an ag gressive variant of CMN. The significance of the potentially aggressiv e 'variant of CMN, atypical mesoblastic nephroma, is discussed and pos sibilities are suggested for management.