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Case Report
1 Radiology Department, Peadiatric Teaching Hospital, Mohammed V University, Rabat, Morocco
Address correspondence to:
Jihane El Houssni
Radiology Department, Peadiatric Teaching Hospital, Mohammed V University, Rabat,
Morocco
Message to Corresponding Author
Article ID: 101346Z01EJ2022
Introduction: Neuroblastoma is the third most common malignancy in pediatrics, subcutaneous metastases of antenatal neuroblastoma are described in the literature and they represent 1% of secondary localizations of neuroblastoma.
Case Report: We report the case of a 12-month-old male infant with an antenatal neuroblastoma of the left adrenal gland revealed by inguino-scrotal and forearm subcutaneous nodules whose anatomopathological study was in favor of cutaneous metastases of a neuroblastoma.
Conclusion: Neuroblastoma is a very frequent embryonic tumor in pediatrics, subcutaneous metastases are often revealing of antenatal neuroblastoma, the diagnosis of certainty is essentially based on anatomopathological study.
Keywords: Adrenal gland, Metastases, Neuroblastoma, Subcutaneous nodules
Neuroblastoma is a malignant solid embryonal tumor very common in pediatrics, originating in sympathetic tissue derived from neural crest cells. Imaging plays an important role in the management of patients with neuroblastoma and is essential to assess the metastatic extension. Subcutaneous metastases represent 1% of neuroblastoma metastases [1]. We report the case of an infant with left adrenal neuroblastoma in whom cutaneous metastases were the telltale sign.
An infant, male, 12 months old, from a consanguineous marriage, the onset of the symptomatology dates back to birth with the presence of subcutaneous nodules in the inguino-scrotal area (Figure 1) and in both forearms, mobile. An ultrasound (US) of the soft tissues was carried out, showing hypoechoic, rounded, well limited, regular contours subcutaneous lesions, poorly vascularized by color Doppler, containing calcifications (Figure 2).
The anatomopathological study of these subcutaneous nodules was in favor of a cutaneous localization of a round cell tumor whose morphological aspect and immunohistochemical profile are compatible with an undifferentiated neuroblastoma (Figure 1).
Abdominal US of this infant revealed a mass in the splenorenal space, oval, heterogeneous, well limited, containing calcifications, vascularized on color Doppler, pushing the kidney up and out with persistence of a separation line, encompassing the renal pedicle which remains however permeable (Figure 2).
Contrast-enhanced computed tomography (CT) performed as part of an extension workup showed a hypodense, heterogeneous, well-limited, with scattered calcifications, retroperitoneal left adrenal mass, enhanced after contrast injection, measuring 31×42×52 mm (AP×H×T). Externally, it encompassed the left renal pedicle without endoluminal invasion, superiorly, it came into contact with the splenic parenchyma with loss of separation line without signs of infiltration, medially, it exceeded the midline and came into contact with the aorta and the celiac trunk, which however remained permeable, this CT also showed a heterogeneously enhanced, suspicious-looking thickening of the medial arm of the right adrenal gland, coelio-mesenteric adenopathies and multiple diffuse subcutaneous abdomino-pelvic, inguino-scrotal, and sacro-coccygeal nodules (Figure 3).
Neuroblastoma is the second most common abdominal tumor in children after Wilms’ tumor [2]. It is the third most frequent malignant tumor in pediatrics [3] with a clear male predominance [2]. Neuroblastoma is metastatic in 75% of cases [4]. It accounts for nearly 15% of cancer deaths in children [2]. Neonatal or antenatal neuroblastoma is described in the literature [2], it is almost always of adrenal origin (90%), it is metastatic in 50% of cases at the time of diagnosis [2], metastatic subcutaneous nodules are frequent in the newborn (32% of neonatal cases) [5]. Wesche et al. reported eight cases of neuroblastoma with cutaneous metastases [6]. Chen et al. described a case of antenatal neuroblastoma with subcutaneous nodules [7].
Our patient presented with a left adrenal neuroblastoma revealed by metastatic subcutaneous nodules present from birth.
Nodules usually occur on the trunk and extremities, other locations have been described such as the scrotum, soles of the feet, and palms of the hands [5].
In our case, the subcutaneous nodules are located in the inguino-scrotal, abdomino-pelvic, and sacro-coccygeal regions.
Ultrasound of superficial soft tissue, these nodules appear as heterogeneous, well-limited nodules with little vascularity on color Doppler [8]. This was like to our patient.
The second skin manifestation reported in patients with neuroblastoma is periorbital ecchymosis (Raccoon eyes) which are secondary to orbital metastases [5].
The main differential diagnoses of cutaneous metastases of neuroblastoma are subcutaneous nodules secondary to congenital TORCH infections (blueberry muffin Sd), histiocytosis, vascular tumors including hemangiomas, cutaneous metastases of hematological malignancies such as lymphoma and leukemia [5],[8].
Neuroblastoma is a very common embryonic tumor in pediatrics, subcutaneous metastases are often revealing of this disease, the diagnosis of certainty is essentially based on anatomopathological study.
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Jihane El Houssni - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Jabour Soukayna - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Siham El Haddad - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Abourak Chaimae - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Saber Abdellah Bassel - Conception of the work, Design of the work, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Tantaoui Mehdi - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Latifa Chat - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Nazik Allali - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
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