Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was a newborn term female who on a routine prenatal ultrasound performed at 38 weeks was noted to have a round echogenic mass in the left posterior mediastinum.
Clinical Physical Exam:
Urine vanillylmandelic acid (VMA) was elevated.
Clinical Differential Diagnosis:
A chest film from the first day of life showed the mass to be in the posterior mediastinum on the left. An MRI exam from the second day of life showed the mass to have intraspinal extension. A chest CT exam from the 3rd day of life showed the mass to be calcified and compromising the airway.
Images 2 and 3
Imaging Differential Diagnosis:
Neuroblastoma, ganglioneuroblastoma, ganglioneuroma
A bone marrow biopsy returned normal cells. Several weeks after birth the mass was surgically biopsied and then resected. The resection included a foraminotomy to remove the intraspinous extension. Unfortunately the tumor was quite adherent to the left subclavian artery and chest wall and could not be completely removed.
Pathological examination of the surgical specimen revealed findings characteristic for ganglioneuroblastoma.
Neuroblastoma, Posterior Mediastinal
Follow-up and Prognosis:
An MRI exam done at 8 weeks of life showed recurrent / residual mass at the original tumor site. A body CT exam from 9 weeks of life showed diffuse hepatic metastases. The patient underwent chemotherapy, without much success.
Case 35, Case 36, Case 42, Case 70
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