Staging/Forms 7 (Nephroblastoma)

Figure tuab_7a_n.jpg: Operative findings of the right kidney of the same patient as in tuab_6a_n.jpg and tuab_6b_n.jpg. View from below: There is a blue string around the right renal vein running to the inferior vena cava, two red strings around the segmental artery running to the lower kidney part and around the right renal artery (on the right side in the picture). Regular upper pole and middle part of the kidney and enlarged lower kidney part. Figure tuab_7b_n.jpg: Border of resection situated in the middle part of the kidney; the lower kidney part has been removed. tuab_7a_n.jpg and tuab_7b_n.jpg: In this kidney mainly the lower part is involved which is supplied by the already demonstrated segmental artery. This enables a partial kidney resection with preservation of the upper pole and middle part of the kidney which are shown in tuab_7b_n.jpg and are responsible for nearly normal renal function. Notice the vital color of the remaining kidney. tuab_7c_n.jpg: Resected part of the right kidney shown from the lower pole. tuab_7d_n.jpg: Resected part of the right kidney shown from the middle part of the kidney. Besides normal kidney tissue, hemorrhage in the calicopelvic system and tumor elements are seen mainly in the right upper quadrant at 12 to 6 o'clock. tuab_7c_n.jpg: The inspection of the preparation in tuab_7c_n.jpg and tuab_7d_n.jpg as well as the resection plane in tuab_7b_n.jpg permit the statement that the nephroblastoma has been completely removed macroscopically (the tumor capsule in tuab_7c_n.jpg and tuab_7d_n.jpg is intact as well). Sometimes it is possible to remove spheric nephroblastoma together with the tumor capsule from the normal kidney tissue (so-called enucleation). With the present-day x-ray techniques it is possible to recognize most bilateral Wilms' tumors preoperatively. Nevertheless, in every unilateral nephroblastoma the contralateral side should be inspected as well and palpated to recognize early small tumors during surgery (= part of staging).