Successful treatment of a solitary skull metastasis in a chi
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An 18-month old girl presented with an abdominal mass on routine well-child visit. A CT scan showed a large intraabdominal mass appearing to arise from the left kidney. At laparotomy, a 15 × 11 × 6 cm mass was encountered, which was found to be arising from the left kidney and compressing the stomach, the pancreas, and the spleen. A small amount of tumor rupture occurred while dissecting the tumor free from the left hemidiaphragm, to which it was adherent. A left radical nephrectomy was performed, along with resection of as much involved diaphragm as was feasible to allow primary repair. Pathology revealed a blastemal-predominant Wilms' Tumor (WT) with multiple foci of anaplasia with positive surgical margins at the diaphragm. Diagnosed with Stage III WT with diffuse anaplasia, she was treated with a combination of vincristine, cyclophosphamide, doxorubicin and etoposide for 24 weeks per Regimen I of the National Wilms Tumor Study V, along with 1080 cGY external beam radiation to the left flank and left lung base/hemidiaphragm....

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