Division of Pediatric Hematology Oncology

Department of Pediatrics, AIIMS Bhopal

NAME: Mohit Mohre AGE: 1yr 11m DOB- 17/06/2021 CR NO:239212300236218
Weight: 10 kg Length: 85.5cm BSA: 0.48m2
Diagnosis: Metastatic Left suprarenal Neuroblastoma Stage 4 (bone, mediastinal LN,
supraclavicular LN, contralateral LN) Unfavorable Histology High Risk (N-Myc Positive)-
progression on chemo- Palliation
Presentation-abdominal distension and pain for 15 days
CT abdomen, Thorax (6/2/23)-A large irregular heterogeneously enhancing lesion in left suprarenal
region 10x12x14cm, calcification+, Loss of fat planes with caudate lobe of liver. Encasing vessels. Mild
BL hydronephrosis, BL LN masses larges 2.6x2.2 cm on rt. Side. Right 7" rib bony metastasis with
pleural nodule 1.5 cm. Lymph nodal mass near rt inferior pulmonary ligament 1.8x1.8 cm size. Left
supraclavicular non enhancing soft tissue sized 1.7x1.6 cm.
Hb- 6.2. WBC-12090Plt=362K, BBVs-Neg PT/APTT/INR- 11.5//1.02
LDH- 2604 Ferritin- uric acid-5.16
HPE (S-862/23)- Small round blue cell tumor
IHC at Core ()- The tumor cells are positive for GATA3, Synatptophysin, ALK, CD56 and negative for
WT1, S100, CD99, DESMIN, NKX2.2, LCA(CD45) Ki67: 80%
BL bone marrow aspiration (14/2/23): normal BM biopsy –normal Bone scan (20/3/23)-no Mets
MIBG scan (16/3/23)- Tracer avid primary in left suprarenal with retroperitoneal and pelvic LNs. Rt
7th rib lytic erosive lesion on SPECT-CT, no MIBG uptake
Hearing-normal Echo- EF=74% FS=37%
N-Myc- positive MLPA-not sent
24 hr. urine catecholamines- HVA- mg/24hr (<4.8) VMA- mg/24hr (<2.2)- Not sent
Rx received –cytoreductive Vinc 0.5 mg, cyclo 115 mg on 14/2/23
Rapid COJEC- 19/2/23 to 11/5/23 LDH-457
CT thorax/abd/pelvis17/5/23)- Left suprarenal mass 8.4x11.9x11.5cm. Loss of fat planes with left
lobe and caudate lobe liver. Encasing pancreas and vessels, iliac LNs 2.6x2.3cm largest. Left
supraclavicular mass 2x1.2 cm het. Enhancing (previous scan- 1.7x1.6 cm nonenhancing). Rt 7th rib
lytic lesion
MIBG(24/5/23)- Left abd and left suprarenal mass uptake+ New lesion in left supraclavicular.
TVD x 3 cycles 8/6/23, 3/7/23, 27/7/23, 14/8/23 (3 doses only)
USG abd (14/8/23)- 11.9x7.3x11 cm mass
Progression on chemo- 17/08/23: Shifting to Palliative oral treatment i/v/o unresponsiveness to
chemo, progressive inability to walk, new scalp lesions, N-Myc positive status, new lesions in bones.
Overall prognosis explained to father and agreed for the same.
Oral Palliative Treatment: (4-week cycle)
Day 1 to 14
Tab Cyclophosphamide 50mg PO x Alt Day (50mg/m2)
Tab Etoposide 50mg PO x Alt Day (50mg/m2)

Day 15 to Day 28
Cap Cis-retinoic Acid 20mg Pox BD (160 mg/m2/day divided in 2 doses)

Cycle CBC Cyclo-Etopo dates Isotretinoin dates

1
2
3
4
5
6

Dr. Nida/ Dr Narendra 17/8/23