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DOI: 10.4103/ijmpo.ijmpo_205_20
A Child with Unusual Liver Lesions in a Case of Neuroblastoma
Financial support and sponsorship Nil.A 21-month-old female initially presented to us with a 2-week history of ataxia, loss of consciousness, bruises on the forehead, nystagmus, tremor, and mydriasis with morning irritability. The findings of magnetic resonance imaging (MRI) of the abdomen were consistent with a neuroblastoma [Figure 1]. At the time of diagnosis, the tumor was localized and showed no evidence of local or regional invasion, as defined by the image-defined risk factors.
On surgery, the tumor was completely excised, with clear margins representing Stage 1 of the International Neuroblastoma Staging System. Histopathology was favorable with differentiating subtype and low Mitosis–Karyorrhexis index. Post surgery, MRI of the abdomen demonstrated no residual soft tissue. This was followed by intravenous immunoglobulin, prednisone, and cyclophosphamide according to standard regimen to treat the opsoclonus myoclonus ataxia syndrome. A stem cell collection was performed for autologous stem cell procedure.
At 3-month follow-up, no tumor recurrence was seen at the surgical bed. However, a single, small lesion with equivocal enhancement was discovered within the liver in segment 6/5, which was thought to be metastases versus hemangioma. Multiple follow-up MRI at 3-month interval showed gradually increasing number and size of lesions in the liver with avid enhancement but no specific washout characteristics. The biopsy of this liver lesion was attempted on two separate occasions, without a definitive diagnosis. The lesions stabilized 2 years postoperatively [Figure 2]. Still, as the possibility of metastases was thought to be highly likely, the tumor board decided to pursue open biopsy for diagnosis. The pathology on the peripheral wedge biopsy of liver surprisingly again showed no evidence of neoplasia [Figure 3]. What could be the cause of such an appearance?
Publication History
Received: 28 April 2020
Accepted: 06 August 2020
Article published online:
17 May 2021
© 2020. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
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