Neuroblastoma

Case contributed by Rad_doc

Presentation

16 month old with 1 month of poor appetite and lethargy. Mom recently noticed a distended belly.

Patient Data

Age: 16 months
Gender: Male
Modality: X-ray

Large soft tissue density in the left upper quadrant displacing bowel inferiorly. No calcifications are identified. 

Your physical exam confirms the presence of an abdominal mass. 

Abdominal Ultrasound

Modality: Ultrasound

Large heterogeneous, solid intra-abdominal mass. It appears to arise from the left retroperitoneum and causes substantial mass effect on the left kidney without appearing to arise from the left renal parenchyma.

CT Abdomen

Modality: CT
  1. Large heterogenously enhancing mass compressing the left kidney.
  2. Cavernous transformation of the portal vein likely secondary to obstruction by mass.
  3. Ascites.
Modality: Annotated image

You will find several annotated studies demonstrating the mass in a fuschia outline. 

Patient went to the operating room and pathologic specimen confirms the diagnosis of Neuroblastoma. 

Case Discussion

Neuroblastomas are the most common extracranial solid childhood malignancies and the third commonest childhood tumours after leukaemia and brain malignancies. The tumours typically occur in infants and very young children (mean age of presentation being ~22 months) with 95% of cases diagnosed before the age of 10 years.

Clinical presentation

Typically with pain or a palpable mass and abdominal distension, although numerous other presentations may be encountered due to local mass effect.

Location

Neuroblastomas arise from the sympathetic nervous system:

Intra-abdominal disease (two-thirds of cases) is more prevalent than the intrathoracic disease. Specific sites include:

  • adrenal glands: most common site of origin, 35%
  • retroperitoneum: 30-35%
  • posterior mediastinum: 20%
  • neck: 1-5%
  • pelvis: 2-3%

See: Neuroblastoma article for more details.

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Case Information

rID: 47939
Case created: 9th Sep 2016
Last edited: 13th Sep 2016
Inclusion in quiz mode: Included

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