Lytic and sclerotic (mixed) vertebral metastasis in ganglioneuroblastoma
A 13-year-old girl presented with a history of abdominal distension, back ache, and loss of appetite and weight of 3 months’ duration. Her medical history was otherwise unremarkable. On examination, an ill-defined mass of 10 cm × 8 cm size was palpable in the right hypochondrial region, extending 7 cm below the right costal margin and medially up to the umbilical region. Ultrasonography of the abdomen revealed a large, heterogeneous mass of 18 cm × 16 cm × 16 cm size arising from the right adrenal, infiltrating the right lobe of liver, and displacing the right kidney inferolaterally.\nFine-needle aspiration cytology (FNAC) of the adrenal mass showed clusters of malignant cells forming rosettes in an eosinophilic fibrillary background with high nuclear cytoplasmic ratio. In addition, scattered ganglion cells with eccentric-placed nuclei and prominent nucleoli were also present and features were consistent with ganglioneuroblastoma [].\nThe 24-h urinary vanillyl mandelic acid VMA level was 5.4 mg/24 h (normal is < 7 mg/24 h). Radiography of the lumbo-sacral spine showed mixed lytic and sclerotic lesion involving the L3 vertebrae [] and confirmed by computed tomography (CT) soft tissue with bone window []. To assess the extent of neuroblastoma and metastasis, PET-CT was done. It showed [Figures and ] increased uptake in the right adrenal and liver areas with metastatic involvement of L3 vertebrae. These imaging findings and FNAC reflected the diagnosis of ganglioneuroblastoma; stage IV (vertebral and liver metastasis). The patient was treated with intravenous zoledronic acid[] and carboplatin, vincristine, etoposide, and cyclophosphamide[] based chemotherapy regimen.