Wilms' tumor in adults is rare, and no treatment guidelines have been established. Spinal cord compression has also been rarely reported in all age groups. In this case report, we present a 19-year-old adolescent with recurrent Wilms' tumor, a paraspinal dumbbell mass, metastatic involvement of the vertebral bodies, lung metastasis, and pregnancy. To our knowledge, this is the first report of a pregnant patient with Wilms' tumor who had to undergo immediate chemotherapy with vincristine and actinomycin-D owing to spinal cord compression at 25 weeks of pregnancy. After delivery, complete remission was maintained with a regimen of ifosfamide, carboplatin, and etoposide and vincristine, actinomycin-D, and cyclophosphamide. No teratogenic or other toxic effects of vincristine or actinomycin-D were observed in the fetus. (C) 2004 Elsevier Inc.