PMC4190830_01
CT scan of the pelvis at the level of the iliac crest reveals a 5.4 cm soft tissue mass. Bones of the pelvis demonstrate abnormal texture.
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Initial computed tomography (CT) scans of the head, chest, abdomen, and pelvis was notable for a 5 cm soft tissue mass in the right pelvis, anterior to the sacrum with a lytic lesion in the left iliac crest (Figure 1).
The H&E stained section of the bone marrow biopsy demonstrates extensive involvement by neuroblastoma with a background of neuropil. Magnification is 400x.
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A repeat bone marrow biopsy performed at our institution demonstrated extensive involvement by metastatic neuroblastoma (Figure 2).
Immunohistochemistry of a paraffin section of the bone marrow biopsy using an antibody directed against synaptophysin demonstrates dense punctate cytoplasmic staining of the tumor cells, including staining of the neuropil. Magnification is 200x.
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Immunohistochemical studies demonstrated strong cytoplasmic staining for tyrosine hydroxylase and synaptophysin in the tumor cells (Figure 3).
Diffuse metastatic involvement of the osseous skeleton consistent with known diagnosis of neuroblastoma with a large right pelvic mass. The two left most panels represent pre-MIBG treatment. The two right-most panels represent images obtained 25 days following therapeutic MIBG.
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She was then treated with therapeutic I131-MIBG (Figure 4), which was well tolerated. Subsequent MIBG imaging obtained 25 days after therapy revealed persistent disease (Figure 4).