You have accessJournal of UrologyHistory of Urology: History Forum1 Apr 2017FRII-03 MAX WILMS: A TRIPHASIC HISTORY OF THE MAN, HIS EPONYMOUS TUMOR, AND ITS EVOLVING TREATMENT Kristina Suson, Yegappan Lakshmanan, and Janae Preece Kristina SusonKristina Suson More articles by this author , Yegappan LakshmananYegappan Lakshmanan More articles by this author , and Janae PreeceJanae Preece More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2452AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Nephroblastoma has been described for over a century. We explored the man behind the eponym, advances in tumor biology, and its how its treatment has evolved since early descriptions. METHODS Literature review of Wilms and nephroblastoma. RESULTS The Man: Born in 1867, Carolus Maximilianus Wilhemus Wilms initially pursued pathology but later secured a position with the surgeon Trendelenburg. During this time, published a three-part monograph, the first of which described mixed renal tumors. He pioneered new approaches to prostatectomy, though his interests extended far beyond urology. During his chief surgeon appointment to a World War I army corps, he became septic after performing a tracheotomy on a prisoner of war with diptheria, dying in 1918. The Tumor: Despite the eponym, Wilms tumor was described before his monograph. Microscopically confirmed as cancer in the 1850s, the mixed histology was not described until 1872. Wilms explored it further, identifying connective tissue, smooth and striated muscle, and epithelium, and proposed an embryologic origin in 1899; he was granted the eponym in 1900. Later pathologists identified traits, such as anaplasia, that impact outcomes and fine-tuned the triphasic elements described by Wilms into blastemal, epithelial and stromal components. Its association with multiple syndromes and occasional familial tumors primed it for genetic insights. Its Treatment: Jessop performed the first successful nephrectomy for nephroblastoma in 1877. Although the boy died 9 months later, he was one of the few early patients to survive nephrectomy for Wilms tumor; there was a debate among the surgical community as to whether surgery was ever appropriate because of the high mortality rate. Survival remained abysmal well into the 20th century. Operative mortality decreased after 1932, but <25% remained alive for ≥2 years. The cure rate jumped to 47% in the 1940s, an improvement attributed to early vessel ligation and post-operative radiation. Survival dramatically increased again with the advent of chemotherapy for Wilms, first reported in 1960. In America (1969) and Europe (1971), multi-center research groups formed to elucidate the best treatments. The groups diverged on the timing of surgery and chemotherapy. Now in an era with improved survival, treatment goals include minimizing morbidity and following long term sequelae. CONCLUSIONS Max Wilms, a man of diverse interests who died a hero, happened upon a biologically fascinating tumor. Its treatment, well-described for over a century, continues to evolve as we identify ways of maximizing survival with the least morbidity. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1067-e1068 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Kristina Suson More articles by this author Yegappan Lakshmanan More articles by this author Janae Preece More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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Jul 19, 2017
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