Ganglioneuroblastoma, intermixed with opsoclonus-myoclonus syndrome

Five Years Follow-up of Opsoclonus-Myoclonus-Ataxia Syndrome-Associated Neurogenic Tumors in Children

AIM

 Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare autoimmune disorder. Approximately half of the cases are associated with neuroblastoma in children. This study's aim is to review management of our cases with OMAS-associated neuroblastoma for treatment approach as well as long-term follow-up.

METHODS

 Age at onset of symptoms and tumor diagnosis, tumor location, histopathology, stage, chemotherapy, OMAS protocol, surgery, and follow-up period were evaluated retrospectively in six patients between 2007 and 2022.

RESULTS

 Mean age of onset of OMAS findings was 13.5 months and mean age at tumor diagnosis was 15.1 months. Tumor was located at thorax in three patients and surrenal in others. Four patients underwent primary surgery. Histopathological diagnosis was ganglioneuroblastoma in three, neuroblastoma in two, and undifferentiated neuroblastoma in one. One patient was considered as stage 1 and rest of them as stage 2. Chemotherapy was provided in five cases. The OMAS protocol was applied to five patients. Our protocol is intravenous immunoglobulin (IVIG) 1 g/kg/d for 2 consecutive days once a month and dexamethasone for 5 days (20 mg/m2/d for 1-2 days, 10 mg/m2/d for 3-4 days, and 5 mg/m2/d for the fifth day) once a month, alternatively by 2-week intervals. Patients were followed up for a mean of 8.1 years. Neuropsychiatric sequelae were detected in two patients.

CONCLUSION

 In tumor-related cases, alternating use of corticosteroid and IVIG for suppression of autoimmunity as the OMAS protocol, total excision of the tumor as soon as possible, and chemotherapeutics in selected patients seem to be related to resolution of acute problems, long-term sequelae, and severity.

Adult adrenal ganglioneuroblastoma: A rare case report

Ganglioneuroblastoma is an uncommon malignant tumour, and it is extremely rare in adults. A 27-year-old woman was admitted to hospital complaining of commitment left loin pain for 7 months accompanied with fever for 1 day. Computed tomography (CT) scan shows a huge cystic solid mass among the rear of the pancreatic body and tail, inside of the spleen, and the top of the left kidney. Hormone examinations showed that the serum levels of glucocorticoid, aldosterone, norepinephrine, and epinephrine were normal. However, neuron-specific enolase (NSE) was significantly higher (289.46 ng/mL, normal level <16.3 ng/mL). Adrenal mass resection was scheduled. However, intraoperative separation was very difficult and adrenal tumour resection, resection of the pancreatic body and tail, left nephrectomy, and splenectomy were carried out. Pathological diagnosis was ganglioneuroblastoma.