PMC8429021_01
Initial axial T2-weighted MRI revealed the soft tissue lesion with a hyperintense signal in axial (a) and coronal (b) views. Abdominopelvic CT scan coronal (c) and axial (d) views show a heterogenic mass (black stars) in the subhepatic along with paraaortic calcified lymph nodes (black arrows).
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T1W, PD, and PDFS sequences showed several fusiform intramuscular and intermuscular lesions up to 15 x 14 mm in size at both thighs, more prominent on the right side, suggestive of neurofibroma. The bone and bone marrow each appeared normal and devoid of any lytic or sclerotic lesion (Figures 1(a) and 1(b)). Subsequently, an abdominopelvic CT scan with contrast demonstrated a large heterogeneous mass in 74 x 70 mm in the subhepatic area with paraaortic and pelvic calcification centers suggesting lymphadenopathy (Figures 1(c) and 1(d)).
Hematoxylin and eosin (H&E) staining showing round cells with scanty cytoplasm arranged in solid nests with pseudo rosette formation (a). In IHC staining, neoplastic cells demonstrate positive immunoreactivity for NSE (b), CD56 (c), and vimentin (d) and negative immunoreactivity for synaptophysin (e) and cytokeratin AE1/AE3 (f).
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Histopathology demonstrated the accumulation of small, dark, round cells with scant cytoplasm arranged in solid nests with pseudo rosette formations along with areas of hemorrhage (Figure 2(a)). Lack of staining for synaptophysin and cytokeratin AE1/AE3 confirmed the diagnosis of neuroblastoma (Figures 2(b)-2(f)).