Adrenal neuroblastoma in an elderly adult: a case report and review of the literature

BACKGROUND: Neuroblastoma is an embryonal malignancy of the autonomic nervous system and is the most common extracranial tumor of early childhood. However, neuroblastoma in adults is rare with an overall incidence of 1 in 10 million adults/year. Adults with neuroblastoma have a significantly worse prognosis than children with neuroblastoma. CASE PRESENTATION: In this case report we describe a 75-year-old Han Chinese woman with bilateral lower extremities weakness, numbness, and fatigue for 1 week. She initially presented as primary hyperaldosteronism with hypertension, persistent hypokalemia, and an elevated aldosterone/plasma renin activity ratio. An abdominal computed tomography scan with intravenously administered contrast showed a solid mass arising from her left adrenal gland. She underwent retroperitoneal laparoscopic surgery that allowed the resection of the mass. Microscopic and immunohistochemical staining, which were positive for synaptophysin, CD56, and vimentin, confirmed the diagnosis of adrenal neuroblastoma. Surgical resection of the tumor was done and no chemotherapy or radiation therapy was done postoperatively. She died from lung and brain metastases 22 months after surgical resection. CONCLUSION: Adrenal neuroblastoma in elderly adults is a very rare disease with sparse data available in the literature. Early stage disease could be managed by surgical resection alone. However, the prognosis is significantly worse than that observed in pediatric patients. Further research focusing on tumor biology and therapy for this rare malignancy in adults may help to improve disease outcome.