Implications of an Underlying Beckwith–Wiedemann Syndrome for Wilms Tumor Treatment Strategies.

Simple Summary: Beckwith–Wiedemann Syndrome (BWS) is one of the five most frequent syndromes predisposing to Wilms tumor (WT). BWS can be underdiagnosed if the phenotype is mild, and WT can be the presenting symptom. The purpose of this review is to summarize the available data in the current literature on the diagnosis, surveillance, treatment strategies, and outcome of WT in the presence of BWS. The awareness of clinical and pathological features of WT suggestive of BWS-associated WT can lead to prompt genetic counselling and, consequently, to the most appropriate treatment. Beckwith–Wiedemann Syndrome (BWS) is a pediatric overgrowth disorder involving a predisposition to embryonal tumors. Most of the tumors associated with BWS occur in the first 8–10 years of life, and the most common is Wilms tumor (WT). BWS clinical heterogeneity includes subtle overgrowth features or even silent phenotypes, and WT may be the presenting symptom of BWS. WT in BWS individuals exhibit distinct characteristics from those of sporadic WT, and the management of these patients needs a peculiar approach. The most important feature is a higher risk of developing bilateral disease at some time in the course of the illness (synchronous bilateral disease at diagnosis or metachronous recurrence after initial presentation with unilateral disease). Accordingly, neoadjuvant chemotherapy is the recommended approach also for BWS patients with unilateral WT to facilitate nephron-sparing surgical approaches. This review emphasizes the importance of early BWS recognition, particularly if a WT has already occurred, as this will result in an urgent consideration of first-line cancer therapy. [ABSTRACT FROM AUTHOR]