Late recurrence of neuroblastoma stage 4S with unusual clinicopathologic findings

The authors present unusual clinicopathologic findings of a patient with ne uroblastoma stage 4S that recurred 11 years after induction of complete rem ission with chemotherapy. A 12-year-old girl presented with recurrent tumor in the liver. Urinary catecholamine metabolites were within normal range i n contrast to the increased values at initial presentation. She underwent l eft lateral segmentectomy and biopsy of the right lobe. Histologic analysis of the recurrent tumor showed undifferentiated neuroblastoma intermingled with mature ganglioneuromatous lesions. There also were scattered ganglione uromatous lesions throughout nontumorous area of the liver. Although multim odal intensified treatments including autologous bone marrow transplantatio n were performed, the patient died of obstinate recurrent tumor at age 14 y ears. The clinicopathologic findings suggested dedifferentiation from the g anglioneuromatous lesion rather than ordinary recurrence of the primary tum or. The current case and the literature review may indicate that long-term follow-up would be necessary for neuroblastoma stage 4/4S cases. J Pediatr Surg 36:953-955. Copyright (C) 2001 by W.B. Saunders Company.