A case of Wilms tumor in patient with retractile testes treated by whole abdominal irradiation with gonodal radiation exposure avoided by immediate orchiopexy

Abstract

We encountered a case of Wilms tumor in a patient who was found to have retractile testes on examination prior to whole abdominal irradiation, thereby avoiding gonodal radiation exposure by immediate orchiopexy. A 3-year-old boy diagnosed as having Wilms tumor stage III was treated at our institute using the standard protocol of the Japan Wilms Tumor Study Group, which consists of up-front surgery, postoperative chemotherapy and whole abdominal irradiation. Radiological and physical examinations before radiotherapy revealed bilateral retractile testes, which were not detected preoperatively. We performed immediate orchiopexy, thus removing both testes from the radiation field in advance. Unlike chryptorchidism, a retractile testis seldom has surgical indications. During whole abdominal irradiation, however, the presence of a retracted testis or cryptorchidism could lead to infertility. Therefore, attending pediatricians and radiation oncologists must rule out retractile testes in patients due to undergo whole abdominal irradiation, so as to avoid unnecessary gonodal radiation exposure.