PMC5390564_01
MRI findings before and after induction chemotherapy. Before induction chemotherapy, the T2-weighted axial image (a) and contrast enhanced coronal images (c, e) revealed a left adrenal mass and multiple bilateral renal masses. After induction chemotherapy, the T2-weighted axial image (b) and contrast enhanced coronal images (d, f) showed that the primary tumor and all lesions in bilateral kidneys had decreased in size.
CRIPE2017-5375091.001.jpg
PMC5390564_01_CRIPE2017-5375091.001.jpg
fig1
Magnetic resonance imaging (MRI) and computerized tomography revealed a left adrenal tumor with calcification and metastases to cranial bones, cranial base, bilateral orbits, left pleura, thoracic paravertebral soft tissue, para-aortic lymph nodes, soft tissue in the sacral canal, and bilateral kidneys (Figures 1(a), 1(c), and 1(e)). Although all of the lesions shrank and serum NSE decreased to within the normal range, there were still residual masses in the primary site, left orbit, sacral canal, and bilateral kidneys after five courses of induction chemotherapy (Figures 1(b), 1(d), and 1(f)).
Histological findings of the primary tumor and a residual mass in the left kidney. In the primary tumor, H&E staining demonstrated neuroblastoma cell clusters (a), and these cells were immunohistochemically positive for (c) synaptophysin, (e) chromogranin A, and (g) CD56. In the left kidney, it was difficult to identify the metastatic lesion due to chemotherapy (b); however, immunohistochemistry revealed the individually scattered neuroblastoma cells (d-h). Note that color reaction was performed using new fuchsin (red), and brown pigments were hemosiderin or ceroid.
CRIPE2017-5375091.002.jpg
PMC5390564_01_CRIPE2017-5375091.002.jpg
fig2
HDC. Histological examination of the resected primary tumor and a biopsy specimen obtained from the left kidney were positive for synaptophysin, chromogranin A, and cluster of differentiation (CD) 56 but not NSE, confirming the presence of tumor cells (Figures 2(a)-2(h)).