Online Exclusives
Treatment of chest wall osteosarcoma presenting as second primary after treatment of neuroblastoma
Only 2 cases of osteosarcoma as a second primary malignancy after neuroblastoma have been reported in the literature. We present a case of chest wall osteosarcoma that developed in a 14-year-old boy 7 years after completion of chemotherapy, autologous peripheral blood stem cell transplantation, radiation, and resection for stage 3, high-risk neuroblastoma. A biopsy of a painful chest wall mass arising from the right third rib diagnosed osteosarcoma. He went on to have preoperative chemotherapy followed by wide local excision and chest wall reconstruction.Prenatal intrarenal neuroblastoma mimicking a mesoblastic nephroma: a case report
Mesoblastic nephroma is by far the most frequent intrarenal fetal tumor. To the best of our knowledge, we report the first case of a newborn with an intrarenal neuroblastoma that was discovered prenatally. An intrarenal echogenic and homogenous mass was observed on routine prenatal ultasonography, corroborated by magnetic resonance imaging, in a 30-week gestation fetus. A male weighing 3280 g was born with elevated blood pressure and cardiac failure. Postnatal ultrasound confirmed a left intrarenal tumor with microcalcifications and perirenal adenopathy.Application of high-dose rate 60Co remote after loading system for local recurrent neuroblastoma
The local control of neuroblastoma is a very important treatment consideration. We describe a patient who received high-dose rate 60Co remote after loading system treatment for local control of recurrent neuroblastoma and discuss the efficacy of high-dose rate 60Co remote after loading system treatment.Excision of ganglioneuroma from skull base to aortic arch
High retropharyngeal neuroblastic tumors in children have been excised and debulked transorally or cervically, often with a covering tracheostomy. Although we and others have approached high thoracic lesions thoracoscopically, the trapdoor incision (or modification thereof) is generally reserved for cervicothoracic tumors with significant vessel encasement around the thoracic inlet. We report a case of symptomatic ganglioneuroma extending from the nasopharynx, at the level of the skull base, down to the aortic arch: macroscopic clearance was achieved via an extended trapdoor incision and without recourse to tracheostomy, transoral surgery, or transfusion.Multiple synchronous tumors in a child with Fanconi anemia
Fanconi anemia (FA) is an autosomal recessive inherited syndrome characterized by congenital abnormalities, aplastic anemia, and a high likelihood of developing cancer. We describe a child who presented with 2 synchronous solid tumors (Wilms tumor and neuroblastoma), later found to have FA, who developed severe toxicity and died after a first cycle of chemotherapy. Our experience emphasizes that a predisposing genetic condition should be sought in cases of multiple tumors and that managing FA patients with cancer can be particularly difficult.Lambert-Eaton myasthenic syndrome revealing an abdominal neuroblastoma
Lambert-Eaton myasthenic syndrome is a paraneoplastic syndrome that may reveal a primitive tumor. Neuroblastoma in children and small cell lung carcinoma in adults are the leading tumors revealed or expressed by paraneoplastic phenomena. The clinical neurologic manifestations of Lambert-Eaton myasthenic syndrome are muscular weakness, sleepiness, absence of reflexes, and dysautonomia. Neurologic manifestations are explained by the induction of an autoimmune response because of the presence of antigens that are expressed by the tumor.Primary paratesticular neuroblastoma: a case report and review of literature
Only 4 infants with primary paratesticular neuroblastoma have been previously described. To the author's knowledge, this case would be the first report of a child who is older than 1 year whose lesion is in his right hemiscrotum. After simple tumorectomy was performed; he was tumor free at 4 years of follow-up. Patients older than 1 year with localized primary paratesticular neuroblastoma may have good prognosis after simple tumorectomy without further therapy.Cervicothoracic neuroblastoma arising from the stellate ganglion in children: the use of muscle and bone sparing transmanubrial transcostal approach
Cervicothoracic neuroblastoma arising from the stellate ganglion in children has always been a challenge to the pediatric surgeon. Localized thoracic neuroblastoma in children has a very good prognosis if excised completely even without adjuvant therapy. Several approaches have been described to resect cervicothoracic neuroblastoma arising from the stellate ganglion with limited success. The muscle and bone sparing transmanubrial transcostal approach which spares the clavicle and the sternomastoid muscle provides excellent exposure for the complete excision of the tumor and excellent functional outcome.An unusual case of neuroblastoma with angiomatoid features
Neuroblastoma is the most commonly occurring solid tumor in children. Most of these neoplasms are diagnosed within the first few years of life. The diagnosis of neuroblastoma may be difficult because of its ability to arise in different locations, its propensity to metastasize, and variable clinical signs and symptoms. Therefore, accurate and timely pathologic diagnosis is imperative. Herein, we present the rare description of an angiomatoid neuroblastoma. Only 1 other case has been previously reported.Bilateral adrenal neuroblastoma and nephroblastoma occurring synchronously in a child with Fanconi's anemia and VACTERL syndrome
Fanconi's anemia (FA) is an autosomal recessive inherited syndrome with a predisposition to malignancy. The association between FA and solid pediatric tumors is extremely rare. The authors report a rare case of VACTERL syndrome associated with FA and multiple solid pediatric tumors occurring in a very young girl. This child had numerous congenital anomalies (horseshoe kidney, cerebella hypoplasia, microcephaly, sacral agenesis) and esophageal atresia, which was repaired in neonatal period. Such association led quickly to the diagnosis of FA.Retroperitoneal hemangioma of infancy
A premature infant presented with an incidental finding of a mass in the retroperitoneum adjacent to the adrenal gland seen on a renal ultrasound study. A clinical diagnosis of neuroblastoma was made based on imaging and laboratory studies; however, upon resection, histological examination revealed a cellular capillary hemangioma of infancy. Hemangioma should be considered in the differential diagnosis of asymptomatic retroperitoneal mass lesions in infants.Postoperative paraplegia secondary to the use of oxidized cellulose (Surgicel)
Iatrogenic paraplegia after thoracic surgery is a devastating complication. In this report, the authors present a case of paraplegia in a toddler after the resection of a mediastinal neuroblastoma. In this case, the paraplegia was caused by spinal cord compression after migration of oxidized cellulose into the spinal canal.The urinary bladder: an extremely rare location of pediatric neuroblastoma
Pediatric malignant tumors in the urinary bladder are rare with a high prevalence of rhabdomyosarcomas. A 15-month-old patient was referred to the authors’ center because of a urinary bladder tumor. Imaging studies disclosed a solid pelvic mass in the dome of the bladder confirmed by a cystoscopy. Surprisingly, the biopsy done during this procedure confirmed a neuroblastoma with a favorable SHIMADA classification. This tumor had no bad prognostic factors. But, vessel compression and local infiltration led to delayed surgery, and neoadjuvant chemotherapy was initiated.
