PMC5618744_01
Heterogeneous mass at the left adrenal gland with smooth borders, containing cystic and hemorrhagic areas.
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The tumor did not cross the midline and no vascular invasion, lymphadenopathy, or metastases to other abdominal organs were detected with MRI (Figure 1).
Normocellular heterogeneous bone marrow demonstrating increased number of mature and immature megakaryocytes.
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There were no tumor cells, pseudorosettes, storage cells, and/or erythrophagocytosis in the bone marrow; thus an immune thrombocytopenia was considered (Figure 2).
Platelet count during the follow-up.
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Immediately after the surgery, platelet count was detected 96000/mm3; it was raised to normal levels at the 36th hour after surgery and remained stable afterwards which supported the diagnosis of ITP (Figure 3).
Neuroblastoma (Schwannian-stroma-poor), differentiating subtype, composed predominantly of differentiating neuroblasts with moderate to abundant acidophilic cytoplasm and enlarged, eccentric nucleus with vesicular chromatin and single prominent nucleolus. Abundant neuropil is also present.
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Tumor histopathology revealed a Schwannian-stroma-poor, differentiating neuroblastoma with low mitotic rate and low mitosis-karyorrhexis index (MKI < 100/5000 cells) (Figure 4).