Composite Tumor

The term "composite" implies that the tumor is composed of histologically and, probably biologically, different clonal populations (Schmidt et al. 1993), a description possibly applicable to almost 10% of pNTs. In the International Neuroblastoma Pathology Classification, this composite form is designated as ganglioneuroblastoma, nodular (composite, Schwannian stroma-rich/stroma-dominant and stroma-poor). In this model the neuroblastic nodule(s) represents the evolution of one or multiple clones,either because of newly acquired genetic aberrations in late stage of tumor progression or the persistence of genetically and biologically distinct variants evolving early in tumor formation. Clinically, two-thirds of these composite tumors are aggressive (Peuchmaur et al. 2003; Umehara et al. 2000).

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