Inflammatory myofibroblastic tumor of the liver after adrenal neuroblastoma surgery: a case report

Abstract

A boy aged 55 months was diagnosed with stage IV Neuroblastoma (NB) of the right adrenal gland 2 years ago. Preoperative chemotherapy was given and he was then treated with retroperitoneal tumor resection and lymph node dissection. After surgery, the children were transferred to the Hemato-Oncology Department for chemotherapy according to the high-risk group NB, with outpatient follow-up every 6 months. In the second postoperative year, abdominal computed tomography (CT) scan revealed a rounded hypodense area in the upper part of the right posterior lobe of the liver, with marked inhomogeneous enhancement in the venous phase after enhancement, which was surgically resected, and postoperative pathology confirmed inflammatory myofibroblastic tumor (IMT) of liver. The patient was not given any special treatment after surgery. In this study, whole transcriptome sequencing was performed on the postoperative specimen of adrenal NB and the specimen of IMT of liver. This unusual case emphasizes the need for close monitoring of second tumor development in NB survivors even in the absence of known predisposing factors.

Keywords: ICG; Inflammatory myofibroblastic tumor; Neuroblastoma; Secondary tumor; Whole transcriptome sequencing.

Fig. 1

The patient’s first physical examination. A A whole-body CT shows a suspicious mass in the right adrenal gland. B CT scan of the head showed bony abnormalities of the frontal parietal bone with soft tissue masses on both sides, metastasis was considered

Fig. 2

FISH assay to detect MYCN gene amplification, green signal for MYCN gene and orange gene for CEP2, × 1000. MYCN gene test result was gain. (Among the counted tumor cells, the MYCN/CEP2 ratio was 1.07, the mean MYCN signal was 2.45, and the mean CEP2 signal was 2.3)

Fig. 3

Hematoxylin and eosin stain of the mass. The patient had preoperative chemotherapy, and the postoperative NB pathological section results showed differentiated type (A: 40 × ; B: 100 ×)

Fig. 4

Abdominal CT showed that the liver was normal in shape and size, and the right lobe of the liver could be seen as a rounded hypodense area, with inhomogeneous enhancement seen in the venous phase, within which enhancement nodules could be seen

Fig. 5

A Hematoxylin and eosin stain of the mass, postoperative pathology shows inflammatory myofibroblastic tumor (40 × ; 100 ×); B Immunohistochemistry for ALK shows strong positivity (100 × ; 200 ×)

Fig. 6

Whole transcriptome sequencing of adrenal NB specimens and liver IMT specimens revealed a large number of differential genes