Spontaneous Regression of Stage IV Neuroblastoma | Spontaneous Remission Database

Case Details

Personal Characteristics

A boy, a. H., was born in india, where his biological mother died from unspecified cancer. The boy, WHO at that time was 8 months old, had half a year earlier been brought to sweden for adoption.

Clinical Characteristics

Previously essentially healthy, the boy was admitted to hospital at 10 months of age with fever and a palpable abdominal mass. An 11 x 7 x 6 centimeter large tumour, deriving from the right adrenal, was surgically removed. Neither local glandular or liver nor distant skeletal or pulmonary metastases were found. Macroscopically the cut surface of the tumour was lobulated, grey-tan with areas of necrosis and hemorrhage. Microscopically the neoplasm consisted of sheets of nuclei and fibrillary material subdivided by fibromuscular septa. The nuclei were vesicular containing a very small nucleolus. A moderate amount of mitoses but no mature ganglion cells were seen. Calcification was present. The fibrous septa and the tumour tissue were moderately infiltrated by lymphocytes. The tumour was histologically interpreted as a differentiated neuroblastoma.

Remission Characteristics

Beginning approximately at the time of steroid withdrawal gradual healing of the metastases ensued with normalisation or near normalisation of the skeletal structure. The patient’s physical and mental development has been completely normal. Today 4 1/2 years after diagnosis of the tumour he lives in good health without any symptoms or signs of recurrence.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

An 11 x 7 x 6 centimeter large tumour, deriving from the right adrenal, was surgically removed. Considering the age of the boy and the seemingly radical extirpation no adjuvant treatment was applied. Recovery was uneventful but for a slight wound infection with culture proved growth of staphylococci. Four weeks after discharge from hospital the patient was readmitted with fever and reduced mobility of the right arm. Roentgenograms of the humerus showed a suspect periosteal reaction but a scintigram was negative. Considering the unspecific manifestations and the previous wound infection, treatment with antibiotics was initiated resulting in abatement of the symptoms.

Non-Clinical Treatment

At this point the condition was regarded incurable and the patient discharged with analgesics described for the increasing skeletal pain. However, the employed drugs proved inadequate pain relief and they were replaced by a daily dose of 15 milligrams prednisolone.