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Joseph Junewick, MD FACR
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Adrenal Neuroblastoma with Metastases

Case Detail

Anatomy: Genitourinary
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: US CT
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3 month old female with abdominal distention.

Case Images


Neuroblastoma, Stage IV-S

Clinical Notes

Normal age adjusted alpha-fetoprotein.
Markedly elevated catecholamines.


US – 1) Enlarged hyperechoic right adrenal gland with loss of zonal differentiation and 2) hepatomegaly with innumerable rounded masses.

CT – Sagittal and coronal reformatted images confirm right adrenal mass and hepatic metastases.


Neuroblastoma is the most common extracranial solid neoplasm in children. Neuroblastoma tumors include neuroblastoma, ganglioneuroblastoma and ganglioneuroma. Neuroblastoma cells are derived from postganglionic sypathetic neuroblasts and are considered one of the “small blue cell” neoplasms.

Neuroblastoma can arise anywhere along the sympathetic chain. Most primary tumors occur in the abdomen (65%) although infants have a higher incidence of cervical and thoracic origin. Metastatic disease occurs by lymphatic (regional lymph nodes) and hematogenous (most often liver, bone, bone marrow, and skin) spread. The signs and symptoms usually reflect the site of origin and metastatic disease although metabolic effects of catecholamine production can also be seen.

Neuroblastoma confined to the organ of origin with metastatic disease limited to the liver, skin or bone marrow represents stage IV-S. This classification generally has favorable outcome.

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