ALL with Bilateral Renal Masses Masquerading as Nephroblasto
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Introduction
Acute lymphoblastic leukemia (ALL) is the most common malignancy in children between ages of 2 and 5 years [1]. The initial clinical presentation of ALL is nonspecific and may include fatigue, fever, infection, bone pain, organomegaly, and anemia secondary to infiltration of blast cells in bone marrow, peripheral blood, and extramedullary organs. As the disease progresses, other organs, such as the kidneys, may be affected. However, renal involvement in the early stages of ALL is rarely seen. This report details the case of a child with bilateral renal lesions resembling nephroblastic rests as the first finding of ALL preceding the development of the classic features of ALL.

Case Report
A four-year-old boy with unremarkable past medical history was seen in the emergency department (ED) with low-grade fever and abdominal pain of a few days duration. A complete blood count (CBC) and abdominal computed tomography (CT) study were performed for evaluation for possible appendicitis. The CBC showed a white blood cell (WBC) count of 8.1 × 109/L with a differential of 22% neutrophils, 68.9% lymphocytes, and an absolute neutrophil count of 1.8 × 109/L, hemoglobin of 13.3?g/dL, and platelets of 170 × 109/L.....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4646991/
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