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The mother of this three-year-old male noticed a large mass in his abdomen. There were no other complaints. Physical examination and x-rays--including an intravenous pyelogram (IVP)--showed a large right renal mass. At surgery, a 550-gram right kidney was removed. There was no lymph node involvement, no extrarenal mass, and no involvement of the other kidney. Lung and bone x-rays showed no metastases. However, microscopic study of the surgical specimen confirmed a diagnosis of Wilms tumor and showed infiltration by the tumor (Grade II neoplasm) which had been difficult to separate from the duodenum. The child was placed on chemotherapy. Four months after the surgery to remove the tumor, a nodule was found in the lungs. The chemotherapy was resumed but the patient died four weeks later due to complications of Gram-negative sepsis.