Abstract
Wilms tumor primarily occurs in children and is extremely rare in adults, with very limited reports. No standardized diagnostic pathway or treatment protocol exists for adult Wilms tumor, especially in elderly patients. We present a case of an 80-year-old man who presented with appetite loss and abdominal bloating, and was diagnosed with WT1-positive Wilms tumor on the basis of contrast-enhanced computed tomography and biopsy findings, including immunohistochemical analysis. Palliative radiation therapy was initiated. However, the tumor rapidly progressed, and the patient died shortly. Autopsy revealed a large mass around the right kidney with multiple organ metastases, and histology confirmed an unfavorable type. To clarify its clinical features, we reviewed the literature dating back to 1975 through PubMed and identified 11 reported cases of patients aged 70 years or older. More than half had an unfavorable histology, and only three survived more than one year after treatment. There were four cases of surgical or treatment-related mortality. Although pediatric protocols, such as the National Wilms Tumor Study, are recommended for adult cases, application in elderly patients remains challenging. Strategies tailored to this population are needed, taking into account poor prognosis as well as comorbidities and performance status.