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Scrotal Pearls
Joseph Junewick, MD FACR
over 7 years ago
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Intraspinal Neuroblastoma

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 8 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: MR CT
Activities:
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History

5 month old with failure to thrive and progressive lower extremity dysfunction.


Case Images


Diagnosis

Neuroblastoma

Findings

CT – Expansile intraspinal neoplasm extending through neural foramina into the paraspinal regions.

MRI – Sagittal T2 and Axial T1, T2 and post-gadolinium T1 images reveal an intermediate signal long segment intraspinal mass, obliterating the thecal sac. Note the scalloping of the posterior aspects of the vertebral bodies and enlarged neural foramina.

Pathology – Poorly differentiated neuroblastoma, stroma poor, low MKI (mitotic karyrrhectic index).

Discussion

Neuroblastoma is the most common extracranial solid neoplasm in childhood. It can arise anywhere along the sympathetic chain from primitive pleuripotential sympathetic cells in the neural crests. The 3 classic histopathologic forms in increasing degrees of maturation are neuroblastoma, ganglioneuroblastoma and ganglioneuroma.

Neuroblastoma has an incidence of 10.5 cases per million per year. The average age at diagnosis is 22 months with approximately one-third cases diagnosed before 1 year of age. The abdomen, evenly divided between the adrenal gland and the paraspinal sympathetic chain, account for toe-thirds of the cases. The incidence of metastatic disease increases with age (~25% < 1 year of age and ~75% over 1 year of age).

Anatomic (CT and MRI) and metabolic (MIBG and FDG) imaging are important in the staging and surveillance of diesease.

Reference

Kushner BH. Neuroblastoma: A Disease Requiring a Multitude of Imaging Studies. J Nuc Med (2004); 45:1172-1188.



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