The patient was a 9-year-old Nigerian boy living in an internally displaced person (IDP) camp with his parents, referred to the Pediatrics Outpatient Clinic of the University of Maiduguri Teaching Hospital (UMTH) from a nongovernmental organization (NGO) facility in a remote village of Borno State, northeastern Nigeria. He presented with progressive abdominal distension (more to the right side) of 5 months, abdominal pain for 2 months, and a 1-month history of cough. The patient started to experience dull-achy non-radiating abdominal pain with no relieving or aggravating factors 3 months after the swelling was noticed, and at the same time he was observed to have progressive weight loss associated with anorexia. The patient experienced an occasional global headache that he described as throbbing and fever with chills and rigors that were relieved by taking acetaminophen. There was no hematuria, facial or leg swelling, focal swelling in other parts of the body, or bone pain. Physical examination revealed a chronically ill-looking wasted febrile child with a temperature of 38.5 °C. The patient was pale but not jaundiced. There was no significant peripheral lymphadenopathy, pedal edema, or visible varicocele. No obvious hemihypertrophy or aniridia was seen. His weight was 21 kg, which is 72% of the expected (underweight). The blood pressure was within normal limits for the patient's age, sex, and height. Abdominal examination revealed a mass in the right flank extending toward the midline. The mass was irregular, firm, non-tender, and slightly mobile. The liver and spleen were not enlarged on palpation, and the left kidney was not ballottable. An abdominal CT scan showed a heterogeneous low-density mass arising from the right kidney crossing the midline to involve the opposite left kidney, and excretory phase images revealed distortion and stretching of the calyces of the part of the left kidney that was relatively spared. There were no intralesional calcifications. CT of the chest showed two discrete nodules in the left upper zone and right lower zone. Urinalysis showed microscopic hematuria (3+) and ova of Schistosoma haematobium, but urine culture was normal. Renal and liver function tests were unremarkable. A presumptive diagnosis of stage V WT in an HK was made based on the contiguous extension of the tumor from the right kidney through the isthmus to the contralateral kidney. The patient received neoadjuvant chemotherapy with vincristine and actinomycin D for 4 weeks and was subsequently scheduled for nephrectomy. The intraoperative finding was an HK with a tumor involving the right kidney, the isthmus, and the lower pole of the left kidney, confirming a preoperative diagnosis of stage V disease. Right nephrectomy, isthmusectomy, and left partial nephrectomy were performed. Grossly, the resected tumor (right kidney, isthmus, and the left kidney lower pole) was irregular and firm, measuring 19 cm × 12 cm × 9 cm. The cut surface appeared variegated, with a mixture of tan brown, grey, and black colors. The histology of the tumor showed a small round blue cell composed of predominantly blastemal cells with foci of epithelial and mesenchymal elements arranged in triphasic patterns invading the renal parenchyma. There was high mitotic activity with focal areas of tumor necrosis and host cellular immune response. The patient’s postoperative condition was unremarkable, and he was continued on adjuvant chemotherapy before he was discharged home. The desire for the patient to have radiotherapy in addition to the chemotherapy was not feasible due to the lack of a radiotherapy facility in our hospital during the period of patient management, and unfortunately, the parents could not afford referral to another hospital. The patient was lost to follow-up after two cycles of adjuvant chemotherapy. All efforts at locating the patient were unsuccessful, as the patient together with his parents were relocated to a remote village that was not readily accessible due to the ongoing insurgency in the northeastern region of Nigeria.