Stars in Cytoplasm: Pediatric Neuroblastoma
A 2-year-old girl presented to the ER with a 1-week history of fever and abdominal pain, along with abdominal distension over the past few months. The fever was undocumented, continuous throughout the day, not relieved through antipyretics. It was associated with diffuse abdominal pain and reduced appetite. There were no associated symptoms of chills and rigors. Her past history was unremarkable, having had a normal birth with no complications. She was not on any medications and there was no history of family illnesses. On examination, the child appeared weak and pale. She was found to be tachycardic but afebrile. There was a palpable mass in the right hypochondrium along with significant tenderness. The rest of the systemic examination was unremarkable. Laboratory investigations revealed Hb 7 g/dl and Hct 25%, an elevated white count of 18 × 109/L, neutrophils 61% and lymphopenia. Platelet count was 242 × 109/L and LDH was elevated to 6,070 IU/L. Serum Ferritin was 1,125 ng/ml. Urine vanillylmandelic acid (VMA) was within normal range. LFTs, electrolytes and urine analysis were within normal limits. Computed tomography (CT) of the abdomen revealed a large mass in the right suprarenal area superiorly invading the liver parenchyma. Biopsy of the mass revealed malignant round blue cell neoplasm. Immunohistochemistry was positive for synaptophysin and CD56. Bone marrow examination showed diffuse infiltration with atypical mononuclear cells and cytogenetic studies showed positivity for NMyc translocation.....