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Unusual presentation of congenital neuroblastoma as persistent respiratory distress and Fever from age of 13 days in an infant: a case report.

Sharma D, Yadav J, Garg E - Iran J Pediatr (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, PtBDS PGIMS Rohtak, Haryana, India.

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Neuroblastoma, an embryonal tumor arising from the sympathetic nervous system, is the most common neonatal malignancy that accounts for >20% of neonatal cancers... The infant was born by normal vaginal delivery with weight of 2.6 kg and Apgar of 7/8/8... Ante-natal period was uncomplicated with normal scans... Baby was referred to us in view of persistence of respiratory distress and X-ray findings... At admission, the infant weighed 2.5 kg, had a temperature of 37.5°C, HR 148/min, RR 50/min, BP 64/42 mm Hg, mild to moderate subcostal and intercostal retractions, air entry decreased on right side, dusky peripheries, SpO2 65% on room air, SpO2 93% with oxygen by hood with flow of 5 liters/min, liver 2cm below costal margin, spleen 1cm below costal margin, pedal edema... Chest X-ray showed right upper lobe heterogeneous opacity and distal consolidation with right lower lobe showing patchy consolidation (Fig. 1)... The infant was started on intravenous antibiotics and supportive care... In view of persistence of respiratory distress repeat X-ray was done after 1 week which didn’t show any improvement (Fig. 2)... Right lower lobe basal segments showed areas of consolidation with curvilinear air lucencies with intercavitory bodies... Biopsy showed small, round, blue cell tumor cells with high nuclear to cytoplasmic ratio and presence of Homer-Wright pseudo rosettes... Undifferentiated neuroblastoma may be difficult to distinguish by electron microscopy from other small-cell malignant tumors... The predominance of blue staining is due to the fact that the cells consist predominantly of nucleus, thus they have scant cytoplasm... Urinary catecholamines are raised in >90% of neuroblastomas but only in 33% of perinatal neuroblastomas... I or I (preferred) meta-iodo benzyl guanidine (MIBG) scintigraphy is highly sensitive and specific.

No MeSH data available.


Chest X-ray after treatment for 1 week
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Figure 2: Chest X-ray after treatment for 1 week

Mentions: Ultrasonography showed hepatosplenomegaly in abdomen and in chest showing intrathoracic soft tissue mass lesion in right paratracheal and upper lobe with distal consolidation of middle and lower lobe. The infant was started on intravenous antibiotics and supportive care. In view of persistence of respiratory distress repeat X-ray was done after 1 week which didn’t show any improvement (Fig. 2). Chest CT scan showed posterior and apical segments of right upper lobe having consolidation without air bronchogram with small central cavitation. Anterior segments of right upper lobe and right middle lobe lateral segment showed nodular lesions. Right lower lobe basal segments showed areas of consolidation with curvilinear air lucencies with intercavitory bodies. Left lower lobe showed multiple confluencing nodular lesions with curvilinear air lucencies (Fig 3). CECT chest showed possibility of metastatic neuroblastoma and Fine needle aspiration cytology (FNAC) and biopsy was planned. FNAC was done which revealed moderate cellular cells which were mostly acute inflammatory cells with atypical tumor cells. Individual cells were round to polygonal cells having scanty to moderate amount of eosinophilic cytoplasm with anisopoikilocytosis with hyperchromasia, high nuclear to cytoplasmic ratio with prominent nucleoli. Biopsy showed small, round, blue cell tumor cells with high nuclear to cytoplasmic ratio and presence of Homer-Wright pseudo rosettes. Baby was started on chemotherapy but infant succumbed to death after 10 days of starting treatment.


Unusual presentation of congenital neuroblastoma as persistent respiratory distress and Fever from age of 13 days in an infant: a case report.

Sharma D, Yadav J, Garg E - Iran J Pediatr (2014)

Chest X-ray after treatment for 1 week
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4442847&req=5

Figure 2: Chest X-ray after treatment for 1 week
Mentions: Ultrasonography showed hepatosplenomegaly in abdomen and in chest showing intrathoracic soft tissue mass lesion in right paratracheal and upper lobe with distal consolidation of middle and lower lobe. The infant was started on intravenous antibiotics and supportive care. In view of persistence of respiratory distress repeat X-ray was done after 1 week which didn’t show any improvement (Fig. 2). Chest CT scan showed posterior and apical segments of right upper lobe having consolidation without air bronchogram with small central cavitation. Anterior segments of right upper lobe and right middle lobe lateral segment showed nodular lesions. Right lower lobe basal segments showed areas of consolidation with curvilinear air lucencies with intercavitory bodies. Left lower lobe showed multiple confluencing nodular lesions with curvilinear air lucencies (Fig 3). CECT chest showed possibility of metastatic neuroblastoma and Fine needle aspiration cytology (FNAC) and biopsy was planned. FNAC was done which revealed moderate cellular cells which were mostly acute inflammatory cells with atypical tumor cells. Individual cells were round to polygonal cells having scanty to moderate amount of eosinophilic cytoplasm with anisopoikilocytosis with hyperchromasia, high nuclear to cytoplasmic ratio with prominent nucleoli. Biopsy showed small, round, blue cell tumor cells with high nuclear to cytoplasmic ratio and presence of Homer-Wright pseudo rosettes. Baby was started on chemotherapy but infant succumbed to death after 10 days of starting treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, PtBDS PGIMS Rohtak, Haryana, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Neuroblastoma, an embryonal tumor arising from the sympathetic nervous system, is the most common neonatal malignancy that accounts for >20% of neonatal cancers... The infant was born by normal vaginal delivery with weight of 2.6 kg and Apgar of 7/8/8... Ante-natal period was uncomplicated with normal scans... Baby was referred to us in view of persistence of respiratory distress and X-ray findings... At admission, the infant weighed 2.5 kg, had a temperature of 37.5°C, HR 148/min, RR 50/min, BP 64/42 mm Hg, mild to moderate subcostal and intercostal retractions, air entry decreased on right side, dusky peripheries, SpO2 65% on room air, SpO2 93% with oxygen by hood with flow of 5 liters/min, liver 2cm below costal margin, spleen 1cm below costal margin, pedal edema... Chest X-ray showed right upper lobe heterogeneous opacity and distal consolidation with right lower lobe showing patchy consolidation (Fig. 1)... The infant was started on intravenous antibiotics and supportive care... In view of persistence of respiratory distress repeat X-ray was done after 1 week which didn’t show any improvement (Fig. 2)... Right lower lobe basal segments showed areas of consolidation with curvilinear air lucencies with intercavitory bodies... Biopsy showed small, round, blue cell tumor cells with high nuclear to cytoplasmic ratio and presence of Homer-Wright pseudo rosettes... Undifferentiated neuroblastoma may be difficult to distinguish by electron microscopy from other small-cell malignant tumors... The predominance of blue staining is due to the fact that the cells consist predominantly of nucleus, thus they have scant cytoplasm... Urinary catecholamines are raised in >90% of neuroblastomas but only in 33% of perinatal neuroblastomas... I or I (preferred) meta-iodo benzyl guanidine (MIBG) scintigraphy is highly sensitive and specific.

No MeSH data available.