PMC9947659_01
Blood pressure value, chest x-ray and abdominal computed tomography (CT) scan of the patient. (A) Line chart of the patient's daily maximum systolic and diastolic blood pressure. (B) In chest x-ray, the scattered patches revealed increased density and right pleural effusion, and the cardiac shadow was enlarged. (C) In the abdominal computed tomography (CT) scan, there was a right pleural effusion and a soft tissue density mass shadow behind the left peritoneum measuring 8.7 cm x 7.1 cm x 9.5 cm, with a CT value of approximately 28-46 HU. Internal density was varied, with calcified density shadow in certain areas. One possibility is neuroblastoma. The pressure is on the left kidney and spleen.
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F1
Following the abnormal physical examination of her abdomen, we further performed an abdominal CT examination, which indicated an 8.7 cm x 7.1 cm x 9.5 cm mass shadow with low density behind the left peritoneum (Figure 1C). Figure 1A depicts the BP changes during the entire treatment period.
The transthoracic echocardiography. (A,B) The transthoracic echocardiography before the tumor resection. (1) The left atrium and ventricle were both enlarged. The ventricular septum and left ventricular free wall were generally thickened. The thicker left ventricular free wall was situated in the middle of the lateral wall, measuring about 14 mm in thickness, while the thicker ventricular septum was situated in the basal segment of the anterior septum, measuring about 12 mm in thickness. The estimated ejection fraction (EF) was about 40%. (2) Both of the bilateral coronary arteries' internal diameters were increased, with the left main coronary artery's diameter measuring 4.1 mm and the right main coronary artery's diameter measuring 3.0 mm. (3) A fluid dark area was observed in the pericardial cavity, 8 mm in the right ventricular sidewall and 4 mm in the apex. (C) The transthoracic echocardiography 3 months after the tumor resection. The left ventricle was mildly enlarged. The left ventricular wall was slightly thickened. The thicker left ventricular free wall was situated in the middle of the lateral wall, measuring about 9.5 mm in thickness, while the thicker ventricular septum was situated in the basal segment of the anterior septum, measuring about 10.6 mm in thickness. The systolic function of the left ventricle was normal. (D) The transthoracic echocardiography 7 months after the tumor resection. The measured values of the internal diameters of each atrioventricular cavity were normal. Each chamber wall's thickness and movement were both typical. The systolic function of the left ventricle was normal.
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F2
After a subsequent follow-up of 3 months, her transthoracic echocardiography showed that the left ventricular wall became thinner than before, and left ventricular systolic function returned to normal (Figure 2C). After 7 months, her transthoracic echocardiography and hs-cTnT values were restored (Figure 2D).
PMC9947659_02
Blood pressure value, chest x-ray and abdominal computed tomography (CT) scan of the patient. (A) Line chart of the patient's daily maximum systolic and diastolic blood pressure. (B) In chest x-ray, the scattered patches revealed increased density and right pleural effusion, and the cardiac shadow was enlarged. (C) In the abdominal computed tomography (CT) scan, there was a right pleural effusion and a soft tissue density mass shadow behind the left peritoneum measuring 8.7 cm x 7.1 cm x 9.5 cm, with a CT value of approximately 28-46 HU. Internal density was varied, with calcified density shadow in certain areas. One possibility is neuroblastoma. The pressure is on the left kidney and spleen.
fped-11-1063795-g001.jpg
PMC9947659_02_fped-11-1063795-g001.jpg
F1
Following the abnormal physical examination of her abdomen, we further performed an abdominal CT examination, which indicated an 8.7 cm x 7.1 cm x 9.5 cm mass shadow with low density behind the left peritoneum (Figure 1C). Figure 1A depicts the BP changes during the entire treatment period.
The transthoracic echocardiography. (A,B) The transthoracic echocardiography before the tumor resection. (1) The left atrium and ventricle were both enlarged. The ventricular septum and left ventricular free wall were generally thickened. The thicker left ventricular free wall was situated in the middle of the lateral wall, measuring about 14 mm in thickness, while the thicker ventricular septum was situated in the basal segment of the anterior septum, measuring about 12 mm in thickness. The estimated ejection fraction (EF) was about 40%. (2) Both of the bilateral coronary arteries' internal diameters were increased, with the left main coronary artery's diameter measuring 4.1 mm and the right main coronary artery's diameter measuring 3.0 mm. (3) A fluid dark area was observed in the pericardial cavity, 8 mm in the right ventricular sidewall and 4 mm in the apex. (C) The transthoracic echocardiography 3 months after the tumor resection. The left ventricle was mildly enlarged. The left ventricular wall was slightly thickened. The thicker left ventricular free wall was situated in the middle of the lateral wall, measuring about 9.5 mm in thickness, while the thicker ventricular septum was situated in the basal segment of the anterior septum, measuring about 10.6 mm in thickness. The systolic function of the left ventricle was normal. (D) The transthoracic echocardiography 7 months after the tumor resection. The measured values of the internal diameters of each atrioventricular cavity were normal. Each chamber wall's thickness and movement were both typical. The systolic function of the left ventricle was normal.
fped-11-1063795-g002.jpg
PMC9947659_02_fped-11-1063795-g002.jpg
F2
After a subsequent follow-up of 3 months, her transthoracic echocardiography showed that the left ventricular wall became thinner than before, and left ventricular systolic function returned to normal (Figure 2C). After 7 months, her transthoracic echocardiography and hs-cTnT values were restored (Figure 2D).
Pathological examination results. (A,B), pathology of a puncture biopsy specimen from a retroperitoneal tumor: Neuroblasts distributed in sheets were seen against the background of nerve fibers. The morphology was compatible with developed neuroblastoma with localized calcification, and the pathological diagnosis showed clear extrusion deformation of histiocytes. (C,D), pathology of biopsy specimen after surgical resection of tumor: (1) morphology was consistent with neuroblastoma (differentiated) with focal calcification. (2) retroperitoneal adrenal neuroblastoma (differentiated) with focal calcification, MKI < 2%. 3) tumor tissue was found in lymph nodes (aside from renal vein) (6/7). Tumor tissue was found in lymph nodes (aside from the abdominal aorta) (2/2). No tumor cells were discovered in lymph nodes (0/1) and (0/1).
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F3
The detailed pathological findings of biopsy (Figure 3A,B) and resection both supported the diagnosis (Figure 3C,D).