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Histological changes of neuroblastic tumors (NTs) in a series of bone marrow (BM) biopsies after multi-cycle chemotherapy
Source publication
The aim of this study is to evaluate the histologic features of metastatic neuroblastic tumors (NTs) in bone marrow (BM) before and after chemotherapy in comparison with those of primary NTs.
A total of 294 biopsies from 48 children diagnosed with NTs with BM metastasis were examined. There were 48 primary neoplasm biopsies, 48 BM biopsies before c...
Context in source publication
Context 1
... neuroblastoma undifferentiated subtype; NBP, neuroblasto- ma poorly differentiated subtype; NBD, neuroblastoma differentiat- ing subtype; GNBN, ganglioneuroblastoma nodular; GNBI, gan- glioneuroblastoma intermixed; GNMI, ganglioneuroma maturing. opsies after further cycles of chemotherapy were found in ten patients, but the degree of differentiation in metastatic foci be- came more prominent (Table 3, Fig. 3). Among the ten cases of persistent bone marrow metastasis, four patients died during the study period (40.0%). ...Similar publications
Objective:
Intracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors' aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neur...
Citations
Background:
Although survival rate among patients with non-high-risk neuroblastoma is excellent, a gross residual tumor (GRT) is often present at the end of treatment. However, reliable data do not exist on the relevance of a GRT for the risk of progression and the role of adjuvant therapy for patients with GRT.
Methods:
A retrospective review of 131 patients with non-high-risk neuroblastoma who underwent chemotherapy was performed. GRT was defined as >1 cm3 residual soft tissue density on end-of-chemotherapy scans. Progression-free survival (PFS) and overall survival (OS) rates were compared between patients with GRT and those without GRT. A proportional hazards model was also used to assess the effects of GRT and adjuvant therapies, including radiation and isotretinoin therapy on outcomes.
Results:
GRT was found in 52 (40%) patients in the study cohort. Correlation was not found between GRT and outcomes (PFS; p = .954, OS; p = .222). In multivariable analysis, GRT remained a nonsignificant predictor of outcome after adjusting for confounders. Local radiation and isotretinoin therapy did not affect outcome for patients with GRT. However, within GRT subgroups, the degree of volume reduction, as well as absolute residual volume in the primary tumor after induction treatment, were significantly associated with outcomes.
Conclusion:
GRT in non-high-risk neuroblastoma may not indicate active disease that requires additional treatment. However, risk of progression is increased in patients with GRT whose response to treatment was less prominent, thus adjuvant therapy should be reserved only for those patients.
Neuroblastoma is the most common extra-cranial solid tumour in children. Bone marrow examination is a part of diagnosis and staging workup of neuroblastoma. Chemotherapy forms mainstay of treatment and post-chemotherapy histological changes are an important indicator of prognosis. A 4-year-old male child came with complaints of fever and hepatomegaly. Investigations revealed a retroperitoneal neuroblastoma. Bone marrow was involved by neuroblasts (stage 4S). Platinum-based chemotherapy was started and post-induction phase bone marrow showed differentiation of neuroblasts to ganglion cells and schwannian stroma (tumour load <5%, minimal disease). The patient was lost to follow up thereafter. The patient returned after one year with the reappearance of neuroblasts (tumour load >20%, relapse) in the bone marrow. Use of immunohistochemical markers like chromogranin and S100 are helpful to map the tumour load and identify the tumour cells when they are sparse. Persistence / reappearance of neuroblasts post-chemotherapy or increasing tumour load indicate a relapse.
