The maturative subtype can be identified only retrospectively after maturation to ganglioneuroma, and represents probably less than 5% of all peripheral neuroblastic tumors. A model of maturation suggests that neuroblastoma cells with spontaneous maturation capacity (not induced by cytotoxic agents) attract and recruit extratumoral Schwann cells that themselves inhibit neuroblastic proliferation and promote maturation (Ambros et al. 1996). So far, parameters that indicate an ongoing or future maturation process are lacking, and it is also unclear whether all gan-
glioneuromas evolve from neuroblastoma. Although some researchers believe that alkylators induce maturation, the majority of investigators feel that chemotherapy does not play a role in the development of ganglioneuroma.
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