Stage4S Neuroblastoma

In the absence of adverse biological factors infants with stage-4S disease have a high incidence of spontaneous regression and an excellent prognosis (see Chaps. 7 and 10).In stage-4S disease the extent of disease is initially evaluated with CT or MR of the head, neck, chest, abdomen and pelvis, and MIBG scintig-raphy; however, once the diagnosis is made and if good biology is confirmed, ultrasonography is a useful method of follow-up. The liver may show persistent heterogeneous echo texture, although focal nodules should eventually resolve (Fig. 10.5). If the mass

Figure 15.5 a-e

Stage-4S Neuroblastoma. Baby presented at 3 days of age. Bone and bone marrow were normal.The patient received no therapy. a Contrast-enhanced CT scan reveals a partially calcified right adrenal mass (arrow) and a low-attenuation liver metastasis (arrowhead). b Ultrasonography at diagnosis reveals a right adrenal mass (arrowhead) and several hepatic nodules (arrows).c Ultrasonography at 6 months of age demonstrates decrease in size of the right adrenal mass (arrow).d Ultrasonography at 11 months of age shows further decrease in size of the adrenal mass (arrow). The liver metastases have resolved.e Ultrasonography at 2years 3 months shows only a residual hyperechoic area (calcification) in the region of the right adrenal gland (arrow)

increases in size or liver lesions progress, patients should be re-evaluated, and treatment may be indicated. Efforts to limit exposure to repeated ionizing radiation from follow-up CT examinations and routine MIBG studies in this group of young infants should be made.

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