Case 70

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

Clinical History:
This was a 15 month old female who had been losing weight for 3 months and now had a two day history of respiratory distress.

Clinical Physical Exam:
The child was in mild respiratory distress.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Thoracic mass lesion

Imaging Findings:
An outside chest film from the day of diagnosis revealed a large left posterior mediastinal mass, which was confirmed on an outside chest CT exam from the same date. An ultrasound guided biopsy of the mass and drainage of the left effusion was performed one day later (not provided) using a 15 gauge biopsy gun. Frozen section showed neuroblastoma. A bone scan and a skeletal survey from one day later after the biopsy were negative for metastatic disease (not provided). An MRI exam of the chest performed 3 weeks after initial diagnosis showed the left adrenal gland was the organ of origin of the mass.

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Imaging Differential Diagnosis:
Neuroblastoma

Operative Findings:
The patient underwent 2 cycles of chemotherapy without response. Seven weeks after the initial diagnosis she underwent a left thoracotomy through a thoracoabdominal incision. The tumor was adherent posteriorly to the chest wall and spine and was seen to be entering the tenth through twelfth neural foramina. The tumor was also adherent to the diaphragm and could be felt going through the diaphragm into the retroperitoneum. The tumor was resected in block.

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Pathological Findings:
Examination of the surgical specimen revealed it to be tan, measuring 12 x 10 x 5 cm in size. There were focal areas of hemorrhage and calcification.

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Final Diagnosis:
Neuroblastoma, Posterior Mediastinal

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 32, Case 35, Case 36, Case 42, Case 70

References:

• Paediapedia
• WebPath
• WebPath
• Cornell University Pediatric Pathology

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