Cutaneously Metastasizing Sympathetic Neuroblastoma with “Spontaneous” Regression

Abstract

There is a group of children with disseminated neuroblastoma with a surprisingly good prognosis. Patients who fit the syndrome can have widespread disease in the liver, skin, and bone-marrow, or any combination of these. The primary tumour in some may be relatively small. Twenty-one of 25 such patients (84%) survived for two years or longer. Radiation therapy and chemotherapy may not be necessary in the management of certain children with this syndrome.

Case Details

Personal Characteristics

An infant, age three weeks, female, second child of healthy parents, weight at birth: 3,300 grams

Clinical Characteristics

Numerous cutaneous metastases secondary to a sympathetic neuroblastoma of the right suprarenal gland, deep-cutaneous to subcutaneous tumours ranging in size from bean size to pigeon-egg size, sturdy consistency, easily moveable, partly a bit stuck to the covering skin and obviously painless upon pressure

Remission Characteristics

At the age of 6 months all the tumours disappeared rapidly. After more than 2 years there has been no relapse

Treatment & Mechanisms

Proposed Remission Mechanisms

The regression of the tumours coincided with an attack of chickenpox and the authors discuss the possibility of the virus having an oncolytic effect

Clinical Treatment

Radiotherapy of one of the cutaneous lesions and the administration of corticosteroids

Additional Notes

The child had developed well with breast-feeding. Findings at admission (August 21, 1957): The body stem and the proximal parts of the lower extremities showed many deep-cutaneous to subcutaneous tumours ranging in size from bean size to pigeon-egg size, of sturdy consistency. They were mainly easily moveable, partly a bit stuck to the covering skin and obviously painless upon pressure. The covering skin was moderately tight and reddened in many places. Apart from that there were no pathological findings on the well-developed infant. In particular palpable tumours of the liver or the spleen were missing. Neither did palpation reveal enlarged lymph nodes under the skin. Peripheral blood picture, erythrocyte sedimentation rate, punctate of the bone marrow, bacteriological blood culture, WaR and side reactions, stool, urine, all x-ray examinations (skeleton and mediastinum) were without pathological findings. The tuberculin reaction according to Moro was negative.