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Pancreatic metastasis in a child suffering with treated stage 4 neuroblastoma.

Kim EY, Yoo SY, Kim JH, Sung KW - Korean J Radiol (2008 Jan-Feb)

Bottom Line: We present here a very rare case of metastatic relapse in the pancreas of a 4-year-old boy who had been treated for stage 4 neuroblastoma.Computed tomography showed multiple metastatic masses in the pancreas with secondary pancreatitis.To the best of our knowledge, this is the first case report of pancreatic metastasis in a child with neuroblastoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, Korea. somatom25@hanmail.net

ABSTRACT
We present here a very rare case of metastatic relapse in the pancreas of a 4-year-old boy who had been treated for stage 4 neuroblastoma. Computed tomography showed multiple metastatic masses in the pancreas with secondary pancreatitis. To the best of our knowledge, this is the first case report of pancreatic metastasis in a child with neuroblastoma.

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Related in: MedlinePlus

A 4-year-old boy with pancreatic metastasis who had been treated for stage 4 neuroblastoma.A. Contrast-enhanced CT scan shows a 2.5 cm sized mass (arrow) in the left adrenal gland. Surgery was performed after chemotherapy. The pathologic diagnosis was ganglioneuroblastoma.B. Contrast-enhanced CT scan demonstrates multiple small low attenuated nodular lesions in the pancreas (arrows).C. CT at three weeks after B shows marked diffuse swelling of the pancreas with an increase in size of multiple pancreatic masses throughout the entire pancreas. There are multifocal peripancreatic fluid collections caused by the combined pancreatitis.D. Abdominal sonography performed two weeks after C shows dilated intrahepatic ducts (arrows) due to obstruction by the pancreatic mass.
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Figure 1: A 4-year-old boy with pancreatic metastasis who had been treated for stage 4 neuroblastoma.A. Contrast-enhanced CT scan shows a 2.5 cm sized mass (arrow) in the left adrenal gland. Surgery was performed after chemotherapy. The pathologic diagnosis was ganglioneuroblastoma.B. Contrast-enhanced CT scan demonstrates multiple small low attenuated nodular lesions in the pancreas (arrows).C. CT at three weeks after B shows marked diffuse swelling of the pancreas with an increase in size of multiple pancreatic masses throughout the entire pancreas. There are multifocal peripancreatic fluid collections caused by the combined pancreatitis.D. Abdominal sonography performed two weeks after C shows dilated intrahepatic ducts (arrows) due to obstruction by the pancreatic mass.

Mentions: A 30-month-old boy initially presented with hip joint pain and fever, which failed to improve despite treatment that was given under the impression of a septic hip at a local hospital. One month later, he was admitted to another hospital due to progressed multifocal bone pain. The physical examination revealed right facial swelling and no palpable abdominal mass. The imaging work up, including bone scanning and MRI for the head, neck and pelvis, suggested multiple metastatic lesions in the skeleton and bone marrow. The abdominal sonography was unremarkable. He was referred to our hospital for further investigation. On admission, a 2.5 cm sized left adrenal mass was detected on the contrast-enhanced CT (Fig. 1A). On the laboratory studies, the serum neuron-specific enolase (NSE) and ferritin, and the urine vanillymandelic acid (VMA) were elevated to 72 ng/ml, 1,245 ng/ml and 42 mg/day, respectively (normal ranges: 0-12 ng/ml, 22-322 ng/ml, and < 3 mg/day, respectively). Metaiodobenzylguanidine (MIBG) scintigraphy showed abnormal diffuse uptake in the whole skeletal system. Biopsy of the bone marrow revealed rosette formations of neuroblastoma cells. Therefore, the patient was diagnosed with stage 4 neuroblastoma of a left adrenal origin, according to the International Neuroblastoma Staging System. Subsequent chemotherapy was started, and this was followed by surgical resection of the residual adrenal lesion several months later. The pathologic diagnosis of the primary lesion was ganglioneuroblastoma with the large portion of the tumor being differentiated into ganglioneuroma, which was caused by the previous chemotherapy. After additional high dose chemotherapy followed by autologous peripheral blood stem cell transplantation, he was clinically considered to be in nearly complete clinical remission. The patient did well until recurrent abdominal pain developed at four years of age. At that time, contrast-enhanced CT scan of the abdomen demonstrated multiple small low attenuated nodular lesions in the pancreas (Fig. 1B). Three weeks later, the laboratory examinations revealed that the amylase and lipase were elevated to 538 U/L and 1,023 U/L, respectively (normal ranges: 13-100 U/L and 13-60 U/L, respectively). Contrast-enhanced abdominal CT showed diffuse swelling of the pancreas with an increase in the size of multiple pancreatic masses throughout the entire pancreas (Fig. 1C). Mild dilatation of the biliary tree was also noted. The chest CT that was performed for a palpable nodule in the sternal area also showed a destructive soft tissue mass of the sternum. MIBG scintigraphy demonstrated newly appeared uptakes in the corresponding areas. The NSE was also elevated to 95 ng/ml (normal range: 0-12 ng/ml). After two weeks, progressive dilatation of the intrahepatic duct was noted on the follow up sonography; this was due to obstruction of the common bile duct by the pancreatic mass (Fig. 1D).


Pancreatic metastasis in a child suffering with treated stage 4 neuroblastoma.

Kim EY, Yoo SY, Kim JH, Sung KW - Korean J Radiol (2008 Jan-Feb)

A 4-year-old boy with pancreatic metastasis who had been treated for stage 4 neuroblastoma.A. Contrast-enhanced CT scan shows a 2.5 cm sized mass (arrow) in the left adrenal gland. Surgery was performed after chemotherapy. The pathologic diagnosis was ganglioneuroblastoma.B. Contrast-enhanced CT scan demonstrates multiple small low attenuated nodular lesions in the pancreas (arrows).C. CT at three weeks after B shows marked diffuse swelling of the pancreas with an increase in size of multiple pancreatic masses throughout the entire pancreas. There are multifocal peripancreatic fluid collections caused by the combined pancreatitis.D. Abdominal sonography performed two weeks after C shows dilated intrahepatic ducts (arrows) due to obstruction by the pancreatic mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627176&req=5

Figure 1: A 4-year-old boy with pancreatic metastasis who had been treated for stage 4 neuroblastoma.A. Contrast-enhanced CT scan shows a 2.5 cm sized mass (arrow) in the left adrenal gland. Surgery was performed after chemotherapy. The pathologic diagnosis was ganglioneuroblastoma.B. Contrast-enhanced CT scan demonstrates multiple small low attenuated nodular lesions in the pancreas (arrows).C. CT at three weeks after B shows marked diffuse swelling of the pancreas with an increase in size of multiple pancreatic masses throughout the entire pancreas. There are multifocal peripancreatic fluid collections caused by the combined pancreatitis.D. Abdominal sonography performed two weeks after C shows dilated intrahepatic ducts (arrows) due to obstruction by the pancreatic mass.
Mentions: A 30-month-old boy initially presented with hip joint pain and fever, which failed to improve despite treatment that was given under the impression of a septic hip at a local hospital. One month later, he was admitted to another hospital due to progressed multifocal bone pain. The physical examination revealed right facial swelling and no palpable abdominal mass. The imaging work up, including bone scanning and MRI for the head, neck and pelvis, suggested multiple metastatic lesions in the skeleton and bone marrow. The abdominal sonography was unremarkable. He was referred to our hospital for further investigation. On admission, a 2.5 cm sized left adrenal mass was detected on the contrast-enhanced CT (Fig. 1A). On the laboratory studies, the serum neuron-specific enolase (NSE) and ferritin, and the urine vanillymandelic acid (VMA) were elevated to 72 ng/ml, 1,245 ng/ml and 42 mg/day, respectively (normal ranges: 0-12 ng/ml, 22-322 ng/ml, and < 3 mg/day, respectively). Metaiodobenzylguanidine (MIBG) scintigraphy showed abnormal diffuse uptake in the whole skeletal system. Biopsy of the bone marrow revealed rosette formations of neuroblastoma cells. Therefore, the patient was diagnosed with stage 4 neuroblastoma of a left adrenal origin, according to the International Neuroblastoma Staging System. Subsequent chemotherapy was started, and this was followed by surgical resection of the residual adrenal lesion several months later. The pathologic diagnosis of the primary lesion was ganglioneuroblastoma with the large portion of the tumor being differentiated into ganglioneuroma, which was caused by the previous chemotherapy. After additional high dose chemotherapy followed by autologous peripheral blood stem cell transplantation, he was clinically considered to be in nearly complete clinical remission. The patient did well until recurrent abdominal pain developed at four years of age. At that time, contrast-enhanced CT scan of the abdomen demonstrated multiple small low attenuated nodular lesions in the pancreas (Fig. 1B). Three weeks later, the laboratory examinations revealed that the amylase and lipase were elevated to 538 U/L and 1,023 U/L, respectively (normal ranges: 13-100 U/L and 13-60 U/L, respectively). Contrast-enhanced abdominal CT showed diffuse swelling of the pancreas with an increase in the size of multiple pancreatic masses throughout the entire pancreas (Fig. 1C). Mild dilatation of the biliary tree was also noted. The chest CT that was performed for a palpable nodule in the sternal area also showed a destructive soft tissue mass of the sternum. MIBG scintigraphy demonstrated newly appeared uptakes in the corresponding areas. The NSE was also elevated to 95 ng/ml (normal range: 0-12 ng/ml). After two weeks, progressive dilatation of the intrahepatic duct was noted on the follow up sonography; this was due to obstruction of the common bile duct by the pancreatic mass (Fig. 1D).

Bottom Line: We present here a very rare case of metastatic relapse in the pancreas of a 4-year-old boy who had been treated for stage 4 neuroblastoma.Computed tomography showed multiple metastatic masses in the pancreas with secondary pancreatitis.To the best of our knowledge, this is the first case report of pancreatic metastasis in a child with neuroblastoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Kangnam-Gu, Seoul, Korea. somatom25@hanmail.net

ABSTRACT
We present here a very rare case of metastatic relapse in the pancreas of a 4-year-old boy who had been treated for stage 4 neuroblastoma. Computed tomography showed multiple metastatic masses in the pancreas with secondary pancreatitis. To the best of our knowledge, this is the first case report of pancreatic metastasis in a child with neuroblastoma.

Show MeSH
Related in: MedlinePlus