Epidural metastasis by Wilms' tumor.

Metastatic spread is common in Wilms' tumor, but spinal epidural involvement is rare. We studied two patients in whom spinal cord compression developed during treatment of Wilms' tumor. Both patients had back pain and new pulmonary metastases months after the primary diagnosis was established. One case had evidence of adjacent vertebral involvement, and successful therapy was begun while the patient had minimal neurological deficits. The second patient had back pain initially without neurological deficit or abnormality on plain spine films, followed in one month by a rapid neurological deterioration. Despite a slow and nearly complete recovery after treatment with laminectomy, radiotherapy, and chemotherapy, her condition relapsed one year later, with a compressive lesion at a higher level. Our experience stresses the importance of early recognition of treatment of this complication of Wilms' tumor.