Calcification in Sympathoblastoma (Neuroblastoma)

Abstract

In a previous paper (8) on primary neoplasms of the sympathetic nervous system, more particularly the sympathoblastoma or so-called neuroblastoma, we mentioned that calcification in the tumors, if noted on the roentgenogram, may be helpful as an aid in preoperative diagnosis. This was merely re-emphasizing an observation made in the literature by numerous pathologists, radiologists, and clinicians. Recent experiences suggest this to be advisable. In 1947, Murray and Stout (9) described the distinctive characteristics of the sympathicoblastoma cultivated in vitro and showed that tissue culture as a method of examination can be very helpful in questionable cases. One of their series of 8 cases (Case 5) was that of a six-year-old boy with a mediastinal mass projecting into the right pleural cavity. It pushed the trachea forward and the arch of the azygos vein downward. The child died three and a half months after operation. “Microscopically the tumor was made up of sympathicoblasts which formed a considerable number of pseudorosettes and was extensively necrotic. It was found in a mediastinal node and involved a partly calcified sympathetic ganglion.” Calcification was also found microscopically in the adrenal of a five-year-old female child, by Bendixen and Lamb (1). Bergstrom (2) reported congenital neuroblastoma with multiple skin nodules and calcification. Chandler and Norcross (4) showed calcification on the x-ray film of the chest of a boy aged six years. Bothman and Blankstein (3) found calcification along the spine in a five-year-old white girl with an adrenal tumor. Holmes and Dresser (5) report autopsy observations of calcification in adrenal neuroblastomas. Lederer (6) 1 Accepted for publication in July 1948. discovered a case roentgenologically in the left adrenal of a girl of four and a half years. Definite calcification was seen by Malisoff (7) on x-ray films showing a large left adrenal mass in a fourteen-year-old colored girl. Parsons and Platt (10) reported calcification in 2 of 6 cases of abdominal neuroblastoma. Both patients were white, one a male aged two and the other a female of six years. In a stillborn seven-month fetus studied by Potter and Parrish (11), necrosis with calcification was present in the tumor. Startz and Abrams (12) found a globular partly calcified mass in the upper lobe of the right lung on an x-ray film of the chest of a colored child. Their report emphasizes the importance of keeping sympathoblastoma in mind in the differential diagnosis of chest tumors, more particularly when calcification is present. One of 3 cases reported by Wolbach and Morse (13), on section of various nodules, showed necrotic tumor tissue with many small gritty areas. Wollstein (14), in a report of 9 cases of neuroblastoma, describes a tumor 18 cm. long, 11 cm. wide, and 37 and 27 cm. in circumference showing many yellow points of calcification, some so hard they grated against the knife.