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Adult Patient With Neuroblastoma Presenting as Acute Leukemia

Neuroblastoma (NB) is the most common extra-cranial cancer of early childhood and rarely occurs in adults. The clinical symptoms of NB can be diverse. We discuss a rare case of an adult NB presenting as acute leukemia. A 45-year-old woman presented with persistent hip pain, weight loss, anemia, and...

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Autores principales: Lin, Yu-Wei, Hsu, Yu-Hsin, Lee, Ming-Yuan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449338/
https://www.ncbi.nlm.nih.gov/pubmed/36106239
http://dx.doi.org/10.7759/cureus.27769
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author Lin, Yu-Wei
Hsu, Yu-Hsin
Lee, Ming-Yuan
author_facet Lin, Yu-Wei
Hsu, Yu-Hsin
Lee, Ming-Yuan
author_sort Lin, Yu-Wei
collection PubMed
description Neuroblastoma (NB) is the most common extra-cranial cancer of early childhood and rarely occurs in adults. The clinical symptoms of NB can be diverse. We discuss a rare case of an adult NB presenting as acute leukemia. A 45-year-old woman presented with persistent hip pain, weight loss, anemia, and incidental fever for several months. Imaging studies showed diffuse bone marrow (BM) uptake and hypermetabolic lesions involving the left adrenal gland, bilateral axillary nodes, and left lateral aspect of the abdomen. Her 24-hour urine catecholamines were within the normal range. On the peripheral blood film, blast-like cells were noted, occupying approximately 2% of leukocytes. The BM imprints showed infiltration of blast-like cells with convoluted nuclei and scant cytoplasm in more than 85% of the total nucleated cells. Acute leukemia was initially suspected based on morphology. Blast-like cells were negative for myeloperoxidase, combined esterase, periodic acid-Schiff, CD45RB, CD68, and CD138. In a further study, these cells were positive for CD56, synaptophysin (SYN), and CD99 with negativity for desmin, myogenin, NKX-2.2, CD31, cytokeratin (AE1/AE3), Melan-A, ERG, S-100, and SALL4. Morphologically similar neoplastic cells in axillary node biopsy were positive for CD56, chromogranin A, SYN, and neurofilament, but negative for GFAP, CD246, and vimentin. Based on laboratory, pathological, and imaging studies, metastatic NB with BM and multifocal involvement was diagnosed. The differential diagnosis of metastatic small blue round cell tumors should be considered for adult patients with circulating blast-like cells, and an accurate diagnosis would enable the patient to receive appropriate and timely treatment.
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spelling pubmed-94493382022-09-13 Adult Patient With Neuroblastoma Presenting as Acute Leukemia Lin, Yu-Wei Hsu, Yu-Hsin Lee, Ming-Yuan Cureus Pathology Neuroblastoma (NB) is the most common extra-cranial cancer of early childhood and rarely occurs in adults. The clinical symptoms of NB can be diverse. We discuss a rare case of an adult NB presenting as acute leukemia. A 45-year-old woman presented with persistent hip pain, weight loss, anemia, and incidental fever for several months. Imaging studies showed diffuse bone marrow (BM) uptake and hypermetabolic lesions involving the left adrenal gland, bilateral axillary nodes, and left lateral aspect of the abdomen. Her 24-hour urine catecholamines were within the normal range. On the peripheral blood film, blast-like cells were noted, occupying approximately 2% of leukocytes. The BM imprints showed infiltration of blast-like cells with convoluted nuclei and scant cytoplasm in more than 85% of the total nucleated cells. Acute leukemia was initially suspected based on morphology. Blast-like cells were negative for myeloperoxidase, combined esterase, periodic acid-Schiff, CD45RB, CD68, and CD138. In a further study, these cells were positive for CD56, synaptophysin (SYN), and CD99 with negativity for desmin, myogenin, NKX-2.2, CD31, cytokeratin (AE1/AE3), Melan-A, ERG, S-100, and SALL4. Morphologically similar neoplastic cells in axillary node biopsy were positive for CD56, chromogranin A, SYN, and neurofilament, but negative for GFAP, CD246, and vimentin. Based on laboratory, pathological, and imaging studies, metastatic NB with BM and multifocal involvement was diagnosed. The differential diagnosis of metastatic small blue round cell tumors should be considered for adult patients with circulating blast-like cells, and an accurate diagnosis would enable the patient to receive appropriate and timely treatment. Cureus 2022-08-08 /pmc/articles/PMC9449338/ /pubmed/36106239 http://dx.doi.org/10.7759/cureus.27769 Text en Copyright © 2022, Lin et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Pathology
Lin, Yu-Wei
Hsu, Yu-Hsin
Lee, Ming-Yuan
Adult Patient With Neuroblastoma Presenting as Acute Leukemia
title Adult Patient With Neuroblastoma Presenting as Acute Leukemia
title_full Adult Patient With Neuroblastoma Presenting as Acute Leukemia
title_fullStr Adult Patient With Neuroblastoma Presenting as Acute Leukemia
title_full_unstemmed Adult Patient With Neuroblastoma Presenting as Acute Leukemia
title_short Adult Patient With Neuroblastoma Presenting as Acute Leukemia
title_sort adult patient with neuroblastoma presenting as acute leukemia
topic Pathology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9449338/
https://www.ncbi.nlm.nih.gov/pubmed/36106239
http://dx.doi.org/10.7759/cureus.27769
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