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Sun X, Xu H, Xin K, Sun B. Neuroblastoma metastasized to the mandible and the spinal extradural regions: A case report. Medicine (Baltimore) 2021; 100:e24399. [PMID: 33907087 PMCID: PMC8084086 DOI: 10.1097/md.0000000000024399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Neuroblastoma (NB) metastasized into the mandible and spinal extradural region was rarely reported. We present a case with metastatic NB to the mandible and the spinal extradural regions. The patient received chemotherapy using NB 97 regimen and was tumor free after 8 months, but 9 months after the treatment, the patient presented with lower limb paralysis and persistent pain in maxillofacial region as well as swelling in the left mandibular area. Metastasis to the mandible and the spinal extradural regions was diagnosed based on the spinal and maxillofacial magnetic resonance imaging. Radiotherapy with a density of 2 Gy per day was given via a linear accelerator. The total dose of the intraspinal occupying lesion was subject to radiotherapy with a regimen of 30 Gy (10 fractions). For the management of the maxillofacial pain, tumor in the maxillofacial region was subject to a density of 50 Gy (25 fractions). The maxillofacial pain disappeared after a density of 10 Gy and soft tissue tumefaction was eliminated after a density of 50 Gy, and the maxillofacial appearance was much better than before. Finally, the patient died from tumor progression 2 years after diagnosis for NB.
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Affiliation(s)
| | - Hui Xu
- Department of Ophtalmology, The First Hospital of Zibo, Zibo, Shandong, China
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do Amaral-Silva GK, Leite AA, Mariz BALA, dos Santos Moreira F, Lopes MA, Ribeiro ACP, Santos-Silva AR, Rocha AC, Vargas PA. Metastatic Neuroblastoma to the Mandible of Children: Report of Two Cases and Critical Review of the Literature. Head Neck Pathol 2021; 15:757-768. [PMID: 33394374 PMCID: PMC8384948 DOI: 10.1007/s12105-020-01277-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/14/2020] [Indexed: 10/22/2022]
Abstract
Neuroblastoma is the most common extracranial solid cancer of infancy, occurring mainly in the adrenal gland, with high metastatic potential. However, involvement of the head and neck region is rare. Here, we present two cases of metastatic neuroblastoma of childhood, in which a mandibular swelling was the first sign of disseminated disease. Case 1 describes a 4-year-old boy with a 2-week history of painful swelling in the left mandibular region, body soreness and weakness. Panoramic radiography and computed tomography showed a destructive lesion in the left mandibular ramus. Case 2 describes a 3-year-old boy with a 1-month history of swelling in the right mandibular area. Panoramic radiograph and cone-beam computed tomography showed a destructive lesion in the right body and ramus of the mandible, displacing tooth germs, with the destruction of vestibular and lingual bone cortices. In both cases, microscopic analyses revealed a diffuse proliferation of small, round, and blue cells with hyperchromatic nuclei and scant cytoplasm. While Case 1 was more undifferentiated, Case 2 presented eosinophilic areas suggestive of neuropil. A large immunohistochemical panel was performed, showing expression of neural markers such as CD56, neuron-specific enolase (in Case 2), chromogranin, and synaptophysin. Both lesions presented a high proliferation index (Ki67 > 70% and 80%, respectively). Positron emission tomography-computed tomography revealed ipsilateral adrenal primary lesions in both cases, with multiple bone metastatic lesions. Besides the mandible, multiple sites of the axial and appendicular skeleton were affected. Treatment consisted of induction chemotherapy, adrenalectomy, consolidation chemoradiotherapy, and post-consolidation therapy.
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Affiliation(s)
- Gleyson Kleber do Amaral-Silva
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, CEP: 13414-903 Brazil
| | - Amanda Almeida Leite
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, CEP: 13414-903 Brazil
| | - Bruno Augusto Linhares Almeida Mariz
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, CEP: 13414-903 Brazil
| | - Fernanda dos Santos Moreira
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, CEP: 13414-903 Brazil
| | - Márcio Ajudarte Lopes
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, CEP: 13414-903 Brazil
| | - Ana Carolina Prado Ribeiro
- grid.488702.10000 0004 0445 1036Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, ICESP-FMUSP, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, CEP: 13414-903 Brazil
| | - André Caroli Rocha
- grid.11899.380000 0004 1937 0722Medical School, Clinics Hospital, University of São Paulo, São Paulo, Brazil
| | - Pablo Agustin Vargas
- grid.411087.b0000 0001 0723 2494Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901, Piracicaba, São Paulo, CEP: 13414-903 Brazil
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