Retroperitoneal neuroblastoma in the adult. An uncommon entity

Neuroblastoma in uncommon age group - A case series diagnosed on cytology

BACKGROUND

Neuroblastoma is the most common extracranial malignant neoplasm in early childhood. It is rare in the adult population.

AIMS AND OBJECTIVES

We aimed to study the incidence of neuroblastoma in the uncommon age group diagnosed on cytology.

MATERIALS AND METHODS

A prospective descriptive study spanning 2 years from December 2020 to January 2022 was done, in which neuroblastoma cases diagnosed by Fine needle aspiration cytology aged >12 years were collected. The clinical, cytomorphological and immunohistochemical findings were studied. Histopathological correlation was done wherever available.

RESULTS

We identified three cases of neuroblastoma during this period. Two cases were middle-aged adults, and one was an adolescent. All cases presented with abdominal masses and revealed small round cell tumor on cytology. Two cases fell into undifferentiated category and one case fell into the poorly differentiated subtype. All cases were positive for neuroendocrine markers. Histopathological correlation was available in two cases. MYC N amplification was absent in all cases.

CONCLUSION

It differs from pediatric neuroblastoma due to the lack of classical histomorphological features and molecular alterations. Adult-onset neuroblastomas carry a worse prognosis than childhood tumors.

Adult neuroblastoma in the retroperitoneum: A case report

RATIONALE

Neuroblastoma is the most common extracranial malignant solid tumor that occurs during childhood. It arises from primitive cells and is found in the adrenal medulla and sympathetic ganglia of the sympathetic nervous system. Huge neuroblastoma in the retroperitoneum, especially adult involvement is extremely rare.

PATIENT CONCERNS

A 20-year-old female patient with complaints of left abdominal discomfort for 1 week was reported.

DIAGNOSIS

Multi-detector computed tomography (MD-CT) of the abdomen revealed a huge enhanced mass in the retroperitoneum. Histopathological findings showed neuroblastoma and immunohistochemical results were as follows: actin(-), CD34(-), CD99(-), CK(-), CgA(+), desmin(-), EMA(-), Ki-67(+, approximately 1%), NSE(+), S-100(+), Syn(+), and vimentin(-).

INTERVENTIONS

We performed a total surgical resection. The CYVADIC (cyclophosphamide, vincristine, adriamycin, and dimethyl triazeno imidazole carboxamide) and James (cyclophosphamide and vincristine) regimens had been administered to this patient.

OUTCOMES

Postoperatively, the patient's symptoms were partially relieved and the patient experienced recurrence after 3 months. The patient did not respond to treatment and died 6 months after the operation.

LESSONS

Besides surgical resection, the treatment also included chemotherapy and radiotherapy. However, the optimal treatment remains controversial. Therefore, we should exert all our energies on the exploration of etiology and targeted drugs for this disease.