Learning Radiology xray montage
 
 
 
 
 

Neuroblastoma
Submitted by Peter Wang, MD


General Considerations

  • Malignant tumor of neural crest cells
  • Most common extracranial solid tumor in infancy
  • 7.8% childhood cancers
  • Most common posterior mediastinal mass in children

Clinical Findings

  • Age at presentation
    • < 1 year – 40%, good prognosis
    • 1-2 years – 35%
    • > 2 years – 25%
    • Older patients, metastatic disease - poor prognosis
  • Lymph nodes, liver, bone
  • 50% present with metastatic disease
  • Clinical signs
    • Mass effect on adjacent organs
    • Metastatic disease
      • >90% with urine homovanillic acid (HVA) and vanillylmandelic acid (VMA)
    • Locations
      • Abdominal Cavity (40% adrenal, 25% paraspinal ganglia)
      • Thoracic 15%
        • Posterior mediastinum
    • Pelvic 5%
    • Cervical 3%
    • Other 12%

Imaging Findings

  • Plain Film
    • Abdominal, chest, cervical mass
    • Calcification
    • Bone erosion (ribs, pedicles)
  • US
    • Heterogeneously echogenic
    • Calcification
    • Doppler for flow in encased vessels
  • CT
    • Lobulated, invasive
    • Encases vessels
    • Inhomogeneous (hemorrhage, necrosis, calcifications)
  • MRI
    • T1WI – hypointense
    • T2WI – bright, heterogeneous
    • Variable enhancement
    • Neural foramina, spinal canal extension
  • Scintigraphy
    • MIBG
    • Uptake by catecholamine producing tumors
    • Primary tumor and metastatic disease
    • Tc-99m MDP (Bone Scan)

Differential Diagnosis

  • Extramedullary hematopoiesis
  • Another neural tumor
  • Sequestration

Treatment

  • Surgery
  • Chemotherapy
  • Bone marrow transplantation

neuroblastoma

neuroblastoma

Mediastinal Neuroblastoma. On the left is a contrast enhanced coronal reformatted CT image of the chest that shows a large left-sided mass of inhomogeneous enhancement that is displacing the heart to the right. A vessel arises from the aorta to feed the mass (black arrow). On the right, a T1 weighted Gadolinium-enhanced MR image shows inhomogeneous enhancement of the mass which appears to have a component arising from the neural foramen (white arrow).
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