Clinical Aspects and Prognostic Factors of Neuroblastoma: Case Report

Abstract

Introduction: Neuroblastoma is an extracranial tumor originated from neural crest cell failures. It’s the most common malignant neoplasm among infants and it presents a very heterogeneous clinical profile. The objective of the article is to report the case of a patient with neuroblastoma in advanced stage and satisfactory survival, despite the poor prognostic factors. Case report: Female patient, 1 year and 4 months old who presented irritability, abdominal distention and intermittent fever with three months of evolution. In physical exam, she presented alopecia suggestive of trichotillomania, cervical, inguinal and axillary lymph node enlargement and abdominal distention. Abdominal computed tomography evidenced expansive mass, measuring 6.8 x 5.8 x 4.0 cm, located in the left anterior pararenal space. Bone scintigraphy and nuclear magnetic resonance showed images suggestive of distant secondary implants. After total tumor excision, it was confirmed poorly differentiated neuroblastoma, with non-amplified MYCN gene and unfavorable histology. Bilateral iliac crest biopsy revealed bone marrow areas occupied by the neoplasm, suggesting bone marrow infiltration. As this was a stage IV neuroblastoma, multimodal therapy was established with adjuvant chemotherapy after surgery, followed by autologous bone marrow transplantation, radiotherapy at the primary site of the lesion and at the sites of bone metastases and use of 13-cis-retinoic acid. Conclusion: Despite presenting several indicators of poor prognosis (age, stage IV, bone metastases, bone marrow infiltration), the patient has been in complete remission of the disease for 39 months.