=Abstract=
A Case of Intrarenal Neuroblastoma
Ai-Ri Han, M.D., Seok-Joo Han, M.D., Jung-Tak Ob, M.D., Seung-Hoon Choi, M.D., Eui-Ho Hwang, M.D.
Division 0/ Pediatric Surgery, Department 0/ Surgery, Yonsei University College 0/ Medicine, Seoul, Korea
Neuroblastoma arises from the embryonic tissue of the adrenergic rest. It is commonly found in children and mostly in nonrenal tissue. We present a case of intrarenal neuroblastoma which was initially thought to be a Wilms' tumor. The patient was a 18 months-old girl treated with radical nephrectomy and adjuvant chemotherapy after operation. The neoplasm within the kidney in children cannot always indicate Wilms' tumor. Neuroblastoma of the adrenal gland or retroperitoneal tissue may often compress or invade the kidney directly or arise from the kidney. Clinical aspects that differentiate between neuroblastoma and Wilms' tumor are discussed with a review of the literatures.
Index Words: Neuroblastoma, Wilms' tumor, Kidney, Children
::i:o}91 -=9=--J!(-~7Jo1]A~ ~A~"8"}~ %oJ % -%l. ;;-?I-]
%oJJ!j- {l7Cls:...-li].¥-%,<:'. iolt- 7a*£~ -g-{- ~~~
91 ~~£ "T-~ ~ ~l€l~-g-o] 1l].lll~ O~~:A]
i't
71] ~S':iql,2. 0] -'f- ~~91 ~l€l~-g-,<:'. n~-i'-
%.R
~J:i] .:::L-3!,<:'. ~].li.llJ{l ~ o1]-=9=-oJ] it,<:'. ;;'}0]7} ~
7]
rrlHI.-
0]q3,4. -lI.-~AJ !l.Jl~ ~lLj!l.'i:! 0}9- s%71] ~ ;<;Jo1JA1 ~ 7~"8"} ~ ~ 7Cl £)'i].¥-%0 ] li!.Jl~ Jl
~~o'j !l.Jl.!{! ~?;j]~ s:..-'f- "T-~ ~ -%l.;;-?I-] %oJ .Q.£ ..2..~~ S':iS':iql,5,7. 0]
'i:!
..2..~91 .stl <j,<:'. -'f- ~~g ~l€l'6}~ 7]~01 9-£ ~;<;J-Jl} %.l!JQ}91 AJ-§.
Correspondence: Seok-Joo Han, M.D., Division of Ped- iatric Surgery, Department of Surgery, Yonsei University College of Medicine, 132 Shinchon-dong, Seodaemoon-ku, Seoul 120-752, Korea
.!f1;;.]-B-J1]oJ] u:};: llJA}~~~ ::i:7,1oJ] t-71"8"}7] u:Jl -lI.-0]q2. 0] Ai] 77}:A] !l.Jl.!{! ll}oJ] 91"8"}'i:! {l;<;JoJ]A~
~A~~ {l7Cls:...-li]~%91 7Cl-i'- 01]-=9=-7\- s:..-'f- y-,>&-ql,6,7.
iolt- ~
't!"=rA-c
{l;<;JoJ]J,~ ~A~"8"}o:j "T-~ ~ -%l.;;-?I-] '60J~£ ..2..~'6}Jl "T-~ -=9=- ~p]7Cl~~ ~-g
oj] 91"5~ ~ 7Cl £.-li].¥-% ~£ ~<j.!{! 011 % 7Cl ~ "6}~
7] oj] o]~ -lI.-~Jlt:[J!j- W7Jl] !l.Jl'6}~ ll}o]q.
~I
1\1
67~-%l. .!{! o:j:At~'i:!0]7t17B-%l.
~ ~7,1'!{! ~ AJ--J!(--¥- '6.l!J ~ 9-5:£ L1l.stl'6mq. ~ot~ Jl}71~~ ~-lt-.g- 2000';'i 6-'11 16-17'\l. t:Jl.:r-<>1l7l 7»~~ All 16
:9:J t:Jl~ ::t.°}.Q.]4~:9:J ~J.1l~iFt:Jl:9:JojlAl .:r-oJ~'3:l%"
- 156-
Fig. 1. Computed tomography findings of the intra renal tumor; showing the intact capsule of the tumor (arrow) and intrarenal hemorrhage (arrow head).
.AJ- ;Z}--'5 1..J1 ~ {} 409-<>1] 7§ .AJ-~
-61
~ ~% ~ 5}o:j El1oj';;;J:.2..oj ~;'~7<l]%-~ 4 kgo]<;ctq. 7}~iEVJ- ~ 0]±7,1 ~ ld<;ctq. *{!.AJ- 17~-%! ~.!f-E~ 3j-.AJ-*.!f-9.1
%-:ilj7} ~Ai~.2..oj ~~ ~ ~±ii};Z] ~~q. ~{l
~~o] 'U<;ct.2-oj T~, ~l:l1~.AJ-g, ~5:5}~q. 0]
'§:j-~ ±7,1.AJ- if.J.,3~~ g, ~.:il 'U<;ct.2..oj °so,FJ-El1 7} ~"$=5~ .Ii!.~q. 7Cl.!f-<>1jJ,1 i:t~5'11::- 1:l~1l..g. ld
<;ctq. *.!f- ~ {HHtl1]<>1] ~01±7,1~ i:t~~;z]
t'.J'
~q. *.!f-~ ll/l~~oj 'U<;ct.2..oj ~J-g ~ ~{!~oj 'U;z] ~~q. 3j-AJ-*.!f-<>1jJ·i lOXl2crn9.1 ';':ilj7}
~;zl~<;ct.2..oj %-:ilj~ %%.J.,30] ld<;ct.:il '?J-~, ~~
'g ~ i:t~~;z] ~~q. y ,,€ ~ .J.]?;~~ *.!f- i g 3i} ~ *.!f- ~{}~ ~~
'fl';Vcl-
%-:ilj1::- :It~ {l~cl- 1..J1<>1] ~~~<;ct.2..oj q]%~9--\<1 1:l~1l.9.1 B]q]7}{! ~ ~ <;ct q(.:L 1:l I). -%l;;~] %-oJ: g, .9.] {] ii}o:j y,,€
g, {! ?;~ ii}~
q.
'2.j: 16 X 13 X 9 crn9.1 %-Jlj 7} 3j-~~*7J-<>11 -\<1;'\1 ii}.:il ~J <;ct.:il ~*7J-g, ~ oj.li!.
Y
%- Jlj ~ 3j-~{}~J-<>1]}.1 7]~~ ~.2..'£ ;.~z.j-~oj ~.2..oj %-:ilj9.1 9--\<1 ~ {}~J-~~.£ %2.W}o:jhj 'U<;ctq.
%:ilj~ q]%~ g, ~~}.:il 'U<;ct.2..oj ~~.2..'£-c 3j-
~ ~7Cl"'-t q2-1(diaphragrnatic crus)~ ~~ ~~5}
~q. q]%~ ~ ii}-t'-%~ 9--\<19.1 ~:ut~01 5'1hj 'Uoj ~017} 9.1{]~<;ctq. y,,€~ 3j-~{}~~~ ~ 1:l ~1l. ~7.cl,,€, ~ 7Cl "'-t.!f-~~A~],,€ g, .J.1?;~ ii}~.:il ~
~-B %Jlj E1 *~ ±7,1.g. .:L 1:l 29.}
{{q.
~~-B%-:iljE1 ~ul7Cl'§:j-31 ±7,1.g. ±~~ A~].¥..7} ~~~
.2..£ i:t ~ ~ oj rosset g, ~ -",3 ii} ~ 'g {} 7Cl S'Ji].¥.. %-
<>1] ~~~ ±7,1 g, .li!.°1.:il 'U~qP1:l 3, 4). ~:A}
1::- y~ ~ ~~~.2..£ if.J.,3{l.!f-~<>1] titi}~.2..oj, y
~ ~ 17~7J}:A1 *"'-tf-~ g, },1?;~~ ~ {}.!f-~<>1]},i
Fig. 2. Gross appeance of the tumor showing the ureter (arrow) and intact capsule of the tumor.
~*~<;ctq. y~ ~ 48~-l'4l VP-16, adriarnycin.2..
.£ t5J-~~'§:j-il..~ g, .J.1?;~()}~q. o]~ o:j-)i ;,\}il1] <>1]
Fig. 3. Microscopic fmding of the tumor, showing the Gerota's fascia (arrow) and small round cells (star) in the renal parenchym (H&E, x 200).
Fig. 4. Microscopic finding of the tumor, showing the glomerulus (thin arrow) and small round cells (thick arrow) (H&E, X 400).
- 157-
~:tl "8J~~"§j-R~~ Al"8~t"}~.2..uj 9-~ ~ 67H~
Zl llJA}{i7<.lli% A l
i>~t"}~.2..t-j-7-}71
i'-~ ~ .AJ~ ~%~ "}~
7,:jA}.AJ *7J 1-11 .;;-:±.
~H~ol 9.l{l£l~q.
~o}~° 1
~ ~{VJEl1 Q{Q.,illl
~ ~ ;=.2..~lil..
-e~ 7<.lli~\i
'i5'
9-~ ~ 97H~ ~noJl A}pJt"}~q.{l?J 1-11 oJVi
~).~ ~{l7d
.:£).~l ~ ~ ~::J. 0117} uH
~
2::.%01
-If:-'~:VJ 16011~01 lil..~£l~ql.5-8.{l?JoJl Ai
~).~ ~{l7d
.:£A~l ~~.g.1 011
~ ~ ~~1.21t"}
~ ~.:£
.!f- 127H~
°VJ91 <?1raoJ1 Al
~:ct£l~q. 9-~ ~ llJA}{i"§j-~7,:jAF'J
{l7d.:£A~l~~~ 91~~ 7d~~~
011£
~~.2..uj 9-~ ~All71B
~:i!l91 -2;-'i!:±':ct.2..~ {l7d.:£).~l~~~ 91~~ 7d~£ ~~q.
9-
~ ~91 011~£
t-j-ll1l}Ai
187H~91 ).~-e71nol 9-~~ ~?J).~-e71nol~q.
01.AJ91
-If:-~.!i!.~oJlrrt
21i'!
{l?JoJl Ai
~).~t"}
~{l7d
.:£A~l ~ ~ ~ ~ ~<?1ra ° 1 1
A~l °l.AJol~.2..uj, .:s:.~ 7d~ ~ ~.y.l ~0J:.2..~ ..2.~
£l~~ 9-~
+91 011+£
t-j-~q. ~7-i7-}%ol 7d
~~
011
~Al 9-~%A191 <?1ra
~I\:!
67H-%l.ol~q .
9-~ ~ llJ-A}{i"§j-~7,:jA}oJVi
~:i!l7} ~'i5'{i~\lO17}
91~~, ~°J:91.J.aZjol
uH~ {l~~01~.2..t-j-, {l?J 1-11
~:i!l~7J}-goJl
~~.y.l ~°J:91 7}~).a~ ).~ztt"}~q. A~l71B ~:i!l ~Al
{l?J 1-11oJl
.;;-~B
~:i!l~7loJl ~ ~.y.l %:i!l~ 91~t"}~.2..t-j- ~ul7cj"§j-3j
7,:jA}~%"8H
{l7d.:£A~l~~~ ~~t"}~~q.::J.t!lJI.
9-~+
97H~~.foJl ).~-et"}7-1 *t"}~q.{l7d.:£A~l~~:i!l- ~ ~.y.l
%°J:91
7J~ ~ 7,:l*E~tt%~~71~01
£'iJ£l1i'!Ai -e-
~~ol9101 Ai
%~oJl
u:}c}Ai
~ ~100 %91 sensitivity9.J- 94.9 %91 specificity7J}7-1 .!i!.JI.t"}JI. 91q 9.
°1r.-1~ {l7d.:s:.).~l~~:i!l- ~ ~.y.l ~0J:~ {}~t"}~ llJ~.g..
1)
~:i!l91..!f17<.1,
~{l?J LljoJl
91~Lf,{l?J91 .21-¥-
~t"l.AJ -¥-oJl
..!f17<.lt"}~Lf,2) %:i!l9.J- 9-R
~~:i!l-91 ~7-l1;=
~li!.7Il Bq2. u:}c}Ai °l'tl
71€'.2..~~{l?J 1-11
~:i!l91 7cj~ {l7d.5'..A~l~~~ 91~t"}Al ~7Il
Bq.
::J.2.1t-j- 2::.%"Clc}£ {l?J 1-1191 %:i!loJl 1:l1iiHAi {l7d
.5'..).~l~~~ {}~t"}o:jo]: t"}~ 7d~7}
91
~ ~oluj~t"l
{l?J 1-11
~:i!loJ1Al ~~~7} ~~£l1i'!Ai JI.~'iJ"0j
~~£l ~ 7d~ {l7d.:£).~l~~9.j7}'o.J.a
~9.j
~t"}o:jo]: ~ ~olql.
°12.H1
{}~~tt91 919.j~::J.
7<.llillJ~'3J 011+
oJl 9101 Ai
.!f- ~:@-oJ1Al;:<.}017} 9171 1IJl-lf:-°lq3. {l 7d
.5'..).~l ~ ~91 7d
~cyclophosphamide, doxorubicin,
platinumA~l ~H,
epiphodophyllotoxin, vincristine ;=
~A}-§-t"}7Il £laj
~j~l~~5\1
).~-e%~58
%~£~lil..JI.£l~
91 q lO-ll.
~ ~.y.l ~0J:9.j 7d~, 9-~~Ai%oj:~ A~j71t"}o:j
t!l71%
~~t"}JI.,ojoJl u:ti/-
iiJ~~%;:<'lli9.J-
llJA}{i;:<.lli ;= 9.j "}7};:<'lli%
~~t"}7IlB q 12.
~%;:<.lli91 7d
~cyclophosphamide, actino- m ycin, vincristine, doxorubicin;=
~{i
12llt"} 711 £1 uj ,
~j~l~ ~ ).~-e% ~
85
%~li!.JI.£l
~9J q
13.012.1
~ {}~~t!-°l ~t"l
{l'i5't"}7Il °lif-01A=jo]:
t"}~7d
~~ 9-~~ llJA}{i"§j-~
7,:jAVJ
~717} ~i>~£l~qJI. :Jtl-t!-£101
9-~ ~ "8J~ ~"§j-R~ ~z1.7-1 {i
12ll
t"}o:j 0]:
~1IJl c}
~ ).~ztBq .
~ 9-~..!f1;:<'loJl
-2-71~ llJA}{i"§j-~~ :Jtl-t!-~ {l7d.:£A~l~%, ~~.y.l
~
oJ:, 71 E!- q := o:j
2.~%fi-9.j
~-&l q := % °j:oJl 1:l1
~
;:<.lli%
.!f-~~t"}7Il *£~9- 9171 1IJl-lf:-°lq.
°19.J- :tH:i£101
~ ~.y.l ~oj:oJl 1:l1~ ~~"§j-~ ~~~ol 9-~ ~ ~%;:<'lli~ ~
+
~~~{l?JoJ1Al renal cell carcinoma7}
~t!-B0117} lil..JI.£lJI. 91q14.
{l7d.:£).~l~%
'3J
~ ~.y.l%°j:91
9-~+ {l71
'091
?JaH~ 7d~t"}7Il£1
~ 7d~7}lil..JI.£lJI. 9Jq I5-18.
~
0119.j 7d
~£
9-~+
~~ ~.2...£ifAa
{l-¥-~ ~ 7d~t"}~q. 9-~+ 17'lJJ7}Al
*~ Jf-~ ~ .J.li>~t"}~.2..uj
°l+oJl£ 7-l14f
~fi-{l?J91 71~~ "}~~~t"}~
q. ° 12.1
~if.J.j
{l-¥-~oJl 1:l1 iiH Ogita ;= 18
~{l
%~91spasmoJl 9.j
~ ~fi-;:<.}1i19.j
7}~.J.j ~,Kaneko ;: 1 5
~%°j:oJl 9.j
~ ~N ~{l
~ ~91;:<.} t!- 91
7}~.J.cJ ~ ~~~q.rrtc}Al
+*~7J1-1191 ~:i!l 9-~oJ1Al 1:l1%~9-~-¥- 9-~~ {l'i5'~71t"}o:jo]:
~ ~oluj ~t"l ~~9.j .21~~
q;:<'l A l
?i'£~t"}
o:jo]:
~ ~01qI9. ~ ~r;j191 7d~ 7H*~ 9-~:±.
:ct°l
uH~ ~"8~-B .AJEl1~.2..uju:}c}Ai
1:l1%~ 9-~-¥-91
'flnj-{i
~78
~ ~.!f- c.1 t"} 711 A 1
i>~t"}
~JI. 01 oJl
9-~
+ if.J.a
{l-¥-~oJl HH}7-17l1 -B
~.2...£ ).~zt B q.
"Cl~71 °12.~~ ~1:l1~
{l?J91
E-.AJ~ 9-~ ~-o-J
~~"§j-
R
~oJl 91 iiH Al
Q{~~9- 91.2..E..'£
~t"l * 9.jt"}o:jo]:
~ ~01q20.{l7d.5'..A~l~~~
:±.0}oJ1Ai
~t"l ~).~t"}~ ~0J:.2..~
.li!.{}{l7d 11 01 9J
~-¥-..!f1
oJ1Al~01 q oJ1Ai t-j-
~ :ct~9-
9J~ ~°J:°lq6. ~-2- 7-17-}~ ~{l?J 1-11oJl A i
~).~~ {l7d.5'..A~l~%oJl1:l1iiH
~ ~.y.l ~0J:.2..~..2.~~ 7d~01 9J~71oJl
01
~ lil..~t"}~l:I}oluj
~t"l %l.-fi-.y.l %0J::i!}
{l7d.£.).~l~%~ {}~t"}~llJA}
- 158-
~~3:j
71rQj t"}L.}7} {lAJ
LJ1 !±-C{lAJ 21011
~~1t"}-'=-4011
uJ--Et:f--c 13%
~Cj-ifuJl {lAJ LJlQj
%-Jlj
011 Ai
~ ~0\1 %-oJ ° 121 Qj 1! %
Jlt>l t"}-c 7014--, {l7clS'Ji1
¥.'b s:.
~~ ~B-Qj t:HAJ01 sq oi OF t"}cj '*
Jl A~2}Bq.
REFERENCES
1. Kessler OJ, Siegel JF, Brock WA: Intrarenal neuroblastoma masquerading as Wilms' tumor.
Urology 51(2):313-316, 1998
2. Peretz GS, Lam AH: Distinguishing neuro- blastoma from Wilms' tumor by computed tomography_ J Comput Assist Tomogr 9(5):
889-893, 1985
3. Massad M, Slim MS, Mansour A, Dabbous I, Firzli S, Issa P: Neuroblastoma: Report on a 21-year experience. J Pediatr Surg 21(5) 388- 391, 1986
4. D'Angio GJ, Evans AE, Beckwith 18, Evans A, Baum H, deLorimier A, Fembach D, Hrabousky E, Kelaris D. Treatment of Wilms' tumor. Result of the third national Wilms' tumor study. Cancer 64(2):349-360, 1989 5. Shende A, Wind ES, Lanzkowsky P: Intra-
renal neuroblastoma mimicking Wilms' tumor.
NY State J Med 79(1):93, 1979
6. Donenias R, Rich MA, Leonides JC, Brock W A: Intrarenal neuroblastoma in children. J Urol 143: 190A, 1990
7. Rosenfield NS, Leonides JC, Barwick KW:
Aggressi.ve neuroblastoma si.mulatmg Wilms' tumor. Radiology 166:165-167, 1988
8. Gohji K, Nakanishi T, Hara I, Hamami G, Kamidono S: Two cases of primary neuro- blastoma of the kidney in adults. J Urol
137(5):966-968, 1987
9. Albregts AE, Cohen MD, Galliani CA: Neu- roblastoma invading the kidney. J Pediatr Surg 29(7):930-933, 1994
10. Grosfeld JL: Neuroblastoma, in O'neill JA, Jr., Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG(eds): Pediatric Surgery(ed 5), chap- ter 26. SI. Louis, Missouri, Mosby Pp 405-417 11. Morris JA, Shochat S, Smith EI Bio
- 159-
logical variables in thoracic neuroblastoma: A Pediatric Oncology Group StUdy. J Pediatr Surg 30:296-303, 1995
12. Othersen HB Jr, Tagge EP, Garvin J: Wilms' tumor, in O'Neill JA Jr, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG(eds): Pediatric Surgery(ed 5), chapter 26. SI. Louis, Missouri, Mosby Pp 405-417
13. Breslow NE, Norkook PA, Olshan A: Second malignant neoplasm in survivors of Wilms' tumor: A report from the National Wilms' Tumor Study. J Nat! Cancer Inst 80: 592·595,
1988
14. Zoeller G, Perkun A, Lakomek M, Ringert RH: Wilms' tumor: the problem of diagnostic accuracy of children undergoing preoperative chemotherapy without histological tumor veri- fication_ J Urol 151:169-171, 1994
15. Kaneko M, Iwakawa M, Ikebukuro K, Oh- kawa H: Complete resection is not required in patients with neuroblastoma under 1 year of age. J Pediatr Surg 33(11):690-4, 1998 16. Day DL, Johnson RT, Odrezin GT, Woods
WG, Alford BA.: Renal atrophy or infarction in children with neuroblastoma. Radiology 180:
L493-495, 1991
17. Kessler 0, Franco I, Jayabose S, Reda E, Levitt S, Brock W: Is contralateral exploration of the kidney necessary in patients with Wilms' tumor ? J Urol 156:693-695, 1996 18. Ogita S, Tokiwa K, Takahashi T: Renal art-
ery spasm: A cause of acute renal failure fol- lowing abdominal surgery for neurobalstoma. J Pediatr Surg 24(4):215-217, 1989
19. Kaneko M, Ohkawa H, Iwakawa M: Is extensive surgery required for treatment of advanced neuroblastoma? J Pediart Surg 32:
1616-1619, 1997
20. Schell M, 3Cochat P, Hadj-A ssa A, Bouffet E, Dubourg L, Brunat-Mentigny M: Renal f\mction following unilateral nephrectomy for neuroblastoma and Wilms' tumor. Pediatr Ne- phrol 9:579·582, 1995
