Left-side Wilms tumor, grade III, class II

Patient M.Sh., 3 years old felt sick in July, 2005; his parents noticed that the child became capricious, wept much, slept badly; gradually, his abdomen begin to swell disproportionally. He was admitted to the Regional hospital with provisional diagnosis of appendicitis; there, USE was carried out and tumor was found in the left kidney. The child was sent to the Research Institute of Oncology where the final diagnosis was established: Wilms tumor, left sided, grade III, class II. In August, 2005, preoperational course of polychemotherapy was carried out; on discharge, tumor regression was reported.

On September 11, the child was again admitted to the hospital for further treatment (case history 5137). The following treatment procedures were planned:

• surgical intervention;
• polychemotherapy;
• radiotherapy.

On September 14, patient had surgery: combined left-sided nephrectomy with adrenalectomy and mesacol on resection. The child tolerated surgery well; postoperative period passed without complications. On September 26, control USE demonstrated that liver is intact. Right kidney of normal size. No focal changes were revealed in the projection of the bed of left kidney and abdominal cavity.

On September 27, 2005, a course of systemic chemotherapy was started. From October 26, 2005 till November 17, 2005, a course of remote gamma therapy was carried out on the left kidney bed (total irradiation dosage 30.78 Gy). The child tolerated the course of radiotherapy without any complications; no leukopenia reported (leukocytes, 4.3x10⁹), deppression of the red cell line of hematopoiesis was not expressed (erythrocytes 2.9x10¹²; hemoglobin 81 g/l).

After discharge on November 30, the child received full-scope polychemotherapy: he received 2 courses of systemic chemotherapy according to GPO protocol: 900 μg dactinomycin per course, 1.6 mg vincristin, and 2 ambulatory courses of chemotherapy: 1.6 mg vincristin and 25 mg doxorubycin per course. No complications were bloodreported. Peripheral blood counts are stable. On February 27, 2006, the next course of chemotherapy was initiated.

The progress in immunological tests of patient Sh., 3 years old

Indices	Rated value	Prior to the transplantation	After 8 days	After 14 days
Lymphocytes, g/l %	0.72–3.60 20–40	0.324 36.0	1.392 48.0	1.666 24.5
T-lymphocytes, g/l %	0.940±0.03 55.18±1.42	0.87 27.0	0.418 30.0	0.500 30.0
B-lymphocytes, g/l %	0.380±0.01 21.4±1.2	0.013 4.0	0.125 9.0	0.133 8.0
O-lymphocytes, g/l %	0.420±0.04 24.6±1.36	0.224 69.0	0.849 61.0	1.032 62.0
TSF	1:128	1:32	1:64	1:32
T-teophilin sensitive lymphocytes	10–19 %	50.0	53.0	29.0

Dynamics of blood indices in patient Sh., 3 years old

Observation terms (days after transplantation)
Indices	Rated value	Before transpl.	6th day	9th day	12th day	R a d i o t h e r a p y 30 Gy	30th day	60th day	P o l y c h e m o t h e r a p y	90th day	P o l y c h e m o t h e r a p y	130th day
		1	2	3	4		5	6		7		8
Erythrocytes, g/l	<4.0–5.5	1.8	1.8	3.5	3.6		2.9	3.4		2.8		3.7
Hemoglobin, g/l	<132–165	60	58.0	70.0	74.0		81.0	94.0		82.0		90.0
Leukocytes, g/l	4–8.8	1.0	1.5	3.4	3.4		4.3	6.7		5.3		4.9
Eosinofils, %	up to 6%		4.0	0.0	—		40.0	14.0		7.0		4.0
Basofils	up to 1%		—	0.0	—		—	—		1.0		—
Young	—		—	2.0	—		2.0	—		1.0		1.0
Stab	up to 6%		4.0	2.0	7.0		4.0	3.0		6.0		9.0
Segmented	up to 70%		35.0	60.0	74.0		11.0	26.0		47.0		27.0
Lymphocytes	20–40		55.0	30.0	14.0		17.0	49.0		25.0		38.0
Monocytes	2–9		2.0	6.0	5.0		24.0	8.0		12.0		15.0
Plasmatic cells	—		—	—	—		—	—		—		—
BGL	—		—	—	—		—	—		2.0		6.0
ESR, mm/hr	<1–10	35.0	65.0	60.0	30.0		40.0	10.0		23.0		7.0