Laboratory Investigations
Blood count revealed hemoglobin 10.5 g/dL, White blood cell 14,500/ µL (with neutrophil 7,900 / µL), platelet 402,000 / µL. Liver function tests: increased GGT 71 U/L (Ref <50 U/L). Serum UEC, calcium, phosphate, magnesium, coagulation profile were within normal limits but increased LDH 3825 IU/l (400 – 1100). Urine Catecholamines. Noradren/Creat ratio: 317.4 (16 – 207). A Cranial CT scan revealed a soft tissue mass on the right orbit, measuring 21x28x30mm. An abdominal ultrasound scan revealed a large suprarenal mass and right paraspinal mass. Abdominal CT showed a large right suprarenal mass consistent with neuroblastoma associated with extensive para-aortic lymphadenopathy and liver metastases. Histopathologies of initial aspirates were done with the results: neuroblastoma tumor (stoma poor, poorly differentiated). MYCN amplification detected. Bone marrow confirmed neuroblastoma and MIGB – Metastases to the liver, bone (skull, proximal humerus, distal femur, right tibia, right distal tibia). With all the clues, he was finally diagnosed with stage 4 high-risk neuroblastoma.