Refractory Anemia as a First Major Sign of Neuroblastoma in 8 Months Old Infant

Background: Neuroblastoma (NB) is the most common malignant solid tumor from the peripheral nervous system. The disease originates from neural crest cells and accounts for 7–10% of malignant tumors among children. NB occurs frequently in infants, with a high degree of malignancy. According to the stage standard of the International Neuroblastoma Staging System (INSS), NB is classified into stages 1–4, with a special stage 4s. Stage 4s cases occur in infants who are

Objective: Our aim is to present accidental finding of retroperitoneal tumor mass in an otherwise clinically “healthy baby”, who had mild refractory anemia.

Methods: Case Report

A case of 8 months old infant with refractory anemia. After 5 month treatment with iron no improvement. Examined by the pediatrician, found palpable mass in right upper part of abdomen. Than referred to radiologist for abdominal ultrasound. Found tumor mass in right suprarenal part. Its character was more precisely shown with abdominal CT with contrast. Immediately surgically treated, tumor mass with 2 lymph nodes totally extirpated.

Results: Blood count-Anemia, Biochemical analysis-Hypoproteinemia, Hyponatriemia, tumor markers Neuron specific enolase in serum (NSE) 171.8 mg/L (↑), Abdominal CT with contrast in right suprarenal part (Right adrenal gland) heterodense tumor mass (97x92 mm) which is repainting after contrast. The right kidney is moved distally and medial. Microscopic and Immunohistochemical staining approved Neuroblastoma 4s stage according to the INSS.

Conclusion: Refractory anemia to the iron treatment and precise examination can be starting point in detecting solid tumors like Neuroblastoma.