Case 32

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
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:
Unremarkable

Clinical Labs:
Urine vanillylmandelic acid (VMA) was elevated.

Clinical Differential Diagnosis:
Neuroblastoma

Imaging Findings:
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.

Image 1

Images 2 and 3

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Imaging Differential Diagnosis:
Neuroblastoma, ganglioneuroblastoma, ganglioneuroma

Operative Findings:
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 Findings:
Pathological examination of the surgical specimen revealed findings characteristic for ganglioneuroblastoma.

Final Diagnosis:
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.

Similar Cases:
Case 35, Case 36, Case 42, Case 70

References:

• Paediapedia
• WebPath
• WebPath
• Cornell University Pediatric Pathology

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