# Adrenal Tumors — GCMD Library living collection

Also covered as: FAP syndrome · tubular adenomas · stage 4 colon cancer · hematochezia · adrenal cortical neoplasm

Experts: Dr. Rae Hanke, Dr. Daniel von Allmen, Dr. Todd Ponsky, Dr. Diana Deason

Updated: n/a · 3 episodes · 116 cited statements

## Episodes
### Foundations
- [Topics in 10: Neuroblastoma](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659) — podcast · 10:25 · [machine version](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659.md)

### Case-Based Learning
- [Neuroblastoma](https://library.globalcastmd.com/watch/neuroblastoma-1620) — podcast · 56:19 · [machine version](https://library.globalcastmd.com/watch/neuroblastoma-1620.md)

### In-Depth Reviews
- [Thyroid Disorders](https://library.globalcastmd.com/watch/thyroid-disorders-302) — podcast · 45:51 · [machine version](https://library.globalcastmd.com/watch/thyroid-disorders-302.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=0) Introduction and Background (Ep 3)
- [2:51](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=171) Initial Evaluation of Thyroid Nodules (Ep 3)
- [6:57](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=417) Diagnostic Workup and Imaging (Ep 3)
- [11:40](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=700) Surgical Management of Papillary Thyroid Cancer (Ep 3)
- [17:40](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1060) Postoperative Management and Risk Stratification (Ep 3)
- [22:53](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1373) Management of Follicular Lesions (Ep 3)
- [27:53](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1673) Benign Nodules and Medullary Thyroid Cancer Introduction (Ep 3)
- [33:32](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2012) Multiple Endocrine Neoplasia Syndromes (Ep 3)
- [39:46](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2386) Medullary Cancer Follow-up and Special Considerations (Ep 3)
- [44:23](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2663) Closing Remarks (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=0) Introduction and Prenatal Diagnosis (Ep 2)
- [2:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=120) Differential Diagnosis and Postnatal Workup (Ep 2)
- [6:47](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=407) MIBG Scanning and Observation Protocol (Ep 2)
- [11:03](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=663) Surgical Approach for Localized Disease (Ep 2)
- [14:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=890) Stage MS Disease with Liver Metastases (Ep 2)
- [18:30](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1110) Workup of Older Child with Abdominal Mass (Ep 2)
- [22:54](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1374) Tissue Biopsy Techniques (Ep 2)
- [30:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1817) Risk Stratification and Staging (Ep 2)
- [36:54](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2214) Central Line Placement and Treatment Initiation (Ep 2)
- [41:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2509) Timing and Goals of Surgical Resection (Ep 2)
- [47:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2860) Surgical Technique and Avoiding Complications (Ep 2)
- [55:22](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3322) Immunotherapy Advances and Closing (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0) Introduction and Clinical Presentation (Ep 1)
- [1:32](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=92) Diagnostic Workup and Staging (Ep 1)
- [3:53](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=233) Surgical Approach and Biopsy (Ep 1)
- [5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345) Risk Stratification and Treatment (Ep 1)
- [9:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=540) Clinical Pearls Summary (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Thyroid nodules are less common in children than adults, but when detected in children they are more likely to be malignant" — Diana Deason (epidemiological) [Ep 3 · 6:23](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=383)
- "When children present with thyroid cancer, they are more likely to have extension outside of the thyroid, regional lymph node involvement, and distant metastasis compared to adults" — Diana Deason (clinical) [Ep 3 · 6:31](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=391)
- "Risk factors for thyroid nodules and cancer include previous exposure to radiation or alkylating agents, such as treatment for Hodgkin's lymphoma, leukemia, or CNS tumors" — Diana Deason (clinical) [Ep 3 · 4:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=248)
- "Thyroid conditions and cancers have familial predisposition including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes" — Diana Deason (clinical) [Ep 3 · 4:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=267)
- "Current ATA recommendations state that hyperfunctioning nodules (hot nodules) do not need to be biopsied if they are going to be resected" — Diana Deason (guideline) [Ep 3 · 8:08](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=488)
- "Ultrasound features suspicious for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, and microcalcifications" — Diana Deason (clinical) [Ep 3 · 9:57](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=597)
- "In adults, lesions less than 1 centimeter are not biopsied, but in pediatric patients size cutoffs cannot be used as in adults; ultrasound characteristics and clinical context determine biopsy indication" — Diana Deason (guideline) [Ep 3 · 11:12](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=672)
- "Papillary thyroid cancer in children shows bilateral disease in up to 30% of patients and multifocal disease in up to 65% of pediatric patients" — Diana Deason (epidemiological) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=900)
- "Current recommendations for papillary thyroid cancer are total or near-total thyroidectomy due to risk of bilateral disease, multifocal disease, increased recurrence risk with lobectomy alone, and ability to optimize for radioactive iodine therapy" — Diana Deason (guideline) [Ep 3 · 15:00](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=900)
- "Nerve monitoring is used routinely during thyroidectomy; while it does not decrease risk of nerve injury, it is helpful in identifying the recurrent laryngeal nerve, especially in patients with bulky cervical disease" — Diana Deason (opinion) [Ep 3 · 17:07](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1027)
- "There is no evidence to support prophylactic lateral neck dissection in pediatric thyroid cancer" — Diana Deason (guideline) [Ep 3 · 18:33](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1113)
- "After total thyroidectomy, PTH level less than 10-15 in recovery indicates higher risk for hypocalcemia and warrants starting calcium replacement or calcitriol" — Diana Deason (clinical) [Ep 3 · 19:37](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1177)
- "Low-risk papillary thyroid cancer (disease confined to thyroid with no metastatic lymph nodes) requires only postoperative thyroglobulin monitoring with TSH goal of 0.5-1, ultrasound at 6 months then annually for 5 years, and no radioactive iodine" — Diana Deason (guideline) [Ep 3 · 21:12](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1272)
- "Intermediate-risk patients (extensive central neck disease or any lateral neck disease) and high-risk patients (extensive regional disease, local invasion, or distant metastasis) receive radioactive iodine postoperatively" — Diana Deason (guideline) [Ep 3 · 21:48](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1308)
- "High-risk papillary thyroid cancer patients have TSH suppression goal of less than 0.1, while low-risk patients have goal of 0.5-1" — Diana Deason (guideline) [Ep 3 · 27:31](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1651)
- "Follicular lesions are indeterminate specimens representing about one-third of FNA results, with three subtypes: follicular lesion of undetermined significance, follicular lesion concerning for neoplasm, and suspicious/suggestive of malignancy with follicular component" — Diana Deason (clinical) [Ep 3 · 23:05](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1385)
- "Follicular lesions of undetermined significance have 5-15% malignancy risk in adults but approximately 28% in pediatric literature" — Diana Deason (epidemiological) [Ep 3 · 24:07](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1447)
- "Follicular neoplasms have reported malignancy rate of 15-30% but more recent data suggests 50-60% in pediatric patients" — Diana Deason (epidemiological) [Ep 3 · 24:18](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1458)
- "Most recent ATA recommendations are that all indeterminate lesions in children be resected due to higher malignancy risk compared to adults" — Diana Deason (guideline) [Ep 3 · 23:50](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1430)
- "Frozen section cannot distinguish follicular adenoma from follicular carcinoma but can identify papillary component" — Diana Deason (clinical) [Ep 3 · 25:04](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1504)
- "Follicular carcinoma with significant vascular invasion or tumor greater than 4 centimeters requires completion thyroidectomy; minimal vascular invasion with smaller tumor can be monitored" — Diana Deason (guideline) [Ep 3 · 26:10](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1570)
- "After lobectomy for benign disease, approximately 30% of patients may develop hypothyroidism at some point, requiring thyroid function monitoring" — Diana Deason (epidemiological) [Ep 3 · 27:01](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1621)
- "For thyroid masses greater than 4 centimeters, the sensitivity and specificity of FNA is decreased, requiring careful follow-up even if benign" — Diana Deason (clinical) [Ep 3 · 28:49](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1729)
- "Benign FNA results should be followed with repeat ultrasound in 6-12 months with repeat biopsy if the mass is enlarging or develops suspicious features" — Diana Deason (guideline) [Ep 3 · 29:02](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1742)
- "Inadequate FNA specimens occur in roughly 1-3% of cases and should be repeated in 3-6 months to avoid picking up atypia from trauma of initial FNA" — Diana Deason (clinical) [Ep 3 · 29:49](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1789)
- "Sporadic medullary thyroid cancer is unusual in children, so routine calcitonin monitoring is not recommended for every pediatric patient with a thyroid nodule" — Diana Deason (guideline) [Ep 3 · 31:34](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1894)
- "Patients with medullary thyroid cancer and calcitonin level greater than 500 at presentation require imaging to exclude metastatic disease including CT neck, CT chest, MRI or CT abdomen, and possibly bone scan" — Diana Deason (guideline) [Ep 3 · 33:01](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=1981)
- "MEN 2A patients can develop medullary thyroid cancer, pheochromocytomas, and hyperparathyroidism" — Diana Deason (clinical) [Ep 3 · 33:36](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2016)
- "MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and Marfanoid habitus with elongated features and joint laxity" — Diana Deason (clinical) [Ep 3 · 33:47](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2027)
- "MEN 2B patients with RET 918 mutation present with thyroid cancer very early, in infancy, with reported cases as young as 3 months" — Diana Deason (clinical) [Ep 3 · 34:11](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2051)
- "MEN 2B patients with 918 mutation should have thyroidectomy before one year of age" — Diana Deason (guideline) [Ep 3 · 34:31](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2071)
- "De novo RET mutations are more likely to be MEN 2B than 2A" — Diana Deason (epidemiological) [Ep 3 · 35:13](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2113)
- "MEN 2A patients are classified as high-risk or moderate-risk based on specific RET codon mutations, with different timing recommendations for prophylactic thyroidectomy" — Diana Deason (guideline) [Ep 3 · 35:42](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2142)
- "MEN 2A high-risk patients (most commonly RET 634 mutation) should have total thyroidectomy before age 5, with surveillance starting at age 3 including calcitonin, CEA, and ultrasounds" — Diana Deason (guideline) [Ep 3 · 36:03](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2163)
- "If calcitonin levels exceed 40 in MEN 2A surveillance, central neck dissection is recommended at time of thyroidectomy" — Diana Deason (guideline) [Ep 3 · 36:27](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2187)
- "Children under age 10 have increased risk of complications from thyroidectomy including hypoparathyroidism and nerve injury due to smaller anatomy" — Diana Deason (clinical) [Ep 3 · 36:36](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2196)
- "MEN 2A moderate-risk patients have thyroidectomy when serum calcitonin becomes elevated or if parents decline frequent surveillance" — Diana Deason (guideline) [Ep 3 · 36:59](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2219)
- "MEN 2A high-risk patients begin pheochromocytoma screening at age 11; moderate-risk patients begin at age 16" — Diana Deason (guideline) [Ep 3 · 37:55](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2275)
- "Central lymph node dissection for medullary thyroid cancer is not necessary if prophylactic thyroidectomy is performed before calcitonin levels exceed 40" — Diana Deason (guideline) [Ep 3 · 39:03](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2343)
- "After medullary thyroid cancer surgery, if calcitonin levels are greater than 150, imaging is needed to detect metastasis including CT neck, CT chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton" — Diana Deason (guideline) [Ep 3 · 40:22](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2422)
- "Systemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors and external beam radiation) has significant side effects and is reserved for progressive disease not treatable with surgery, not used routinely for elevated calcitonin alone" — Diana Deason (guideline) [Ep 3 · 41:38](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2498)
- "In young children with Graves' disease, surgery is often preferred over radioactive iodine due to concerns about risks of secondary malignancies from radioactive iodine" — Diana Deason (opinion) [Ep 3 · 42:29](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2549)
- "Diffuse infiltration of the thyroid (rather than discrete nodule) is a characteristic of papillary thyroid cancer that is more common in children and should prompt biopsy especially if suspicious lymph nodes are present" — Diana Deason (clinical) [Ep 3 · 43:52](https://library.globalcastmd.com/watch/thyroid-disorders-302?t=2632)
- "Neuroblastoma is the most common extracranial solid tumor in children" — Rae Hanke (epidemiological) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0)
- "The majority of neuroblastoma cases occur in children less than a year old" — Rae Hanke (epidemiological) [Ep 1 · 0:00](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0)
- "Younger patients are often picked up prenatally on ultrasound or as a solid abdominal mass in two- or three-year-olds" — Daniel von Allmen (clinical) [Ep 1 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "Patients with metastatic disease may present with bony pain or neurologic symptoms from cord compression" — Daniel von Allmen (clinical) [Ep 1 · 0:41](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "Catecholamines (urine or serum) are one of the most diagnostic laboratory tests for neuroblastoma" — Daniel von Allmen (clinical) [Ep 1 · 1:07](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=67)
- "Cross-sectional imaging (CT or MRI) is obtained after initial ultrasound and laboratory workup" — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "MIBG study is helpful for confirming neuroblastoma diagnosis and demonstrating metastatic disease" — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "About 10% of neuroblastomas are MIBG negative" — Daniel von Allmen (clinical) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "Some centers obtain a PET scan for MIBG-negative cases to look for tumor uptake and metastatic disease" — Daniel von Allmen (clinical) [Ep 1 · 2:20](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "The INRGSS staging system allows stage assignment before any invasive procedure" — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "Localized tumors without image-defined risk factors are categorized as L1" — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "Localized tumors with image-defined risk factors (encasing nerves or vessels) are L2" — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "Tumors with metastatic disease are categorized as M" — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "MS category is for children less than 18 months with metastases to bone marrow or skin" — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "The INRGSS was created to allow studies from different centers and countries to be compared based on pre-surgical staging" — Daniel von Allmen (guideline) [Ep 1 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "The prior staging system required tissue diagnosis before assigning a stage" — Daniel von Allmen (guideline) [Ep 1 · 3:36](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "A patient with a resectable adrenal mass and positive MIBG without metastases can be treated with primary resection via laparotomy or laparoscopy" — Daniel von Allmen (clinical) [Ep 1 · 4:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- "For large central abdominal tumors that encase major vasculature, only tissue for diagnosis is needed via open biopsy, laparoscopic biopsy, or core needle biopsy" — Daniel von Allmen (clinical) [Ep 1 · 4:44](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=284)
- "NMIC status is the most important biologic risk determinant from biopsy tissue" — Daniel von Allmen (clinical) [Ep 1 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "1P and 11Q deletions should be assessed in biopsy tissue along with Shimada histology" — Daniel von Allmen (clinical) [Ep 1 · 5:14](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "Neuroblastoma risk categories are very low risk, low risk, intermediate risk, or high risk" — Daniel von Allmen (guideline) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- "Risk distribution is approximately 50-50 between low risk categories and high risk, with a smaller percentage intermediate risk" — Daniel von Allmen (epidemiological) [Ep 1 · 5:45](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- "NMIC amplification and age greater than 18 months are the most important prognostic determinants for neuroblastoma" — Daniel von Allmen (clinical) [Ep 1 · 6:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=366)
- "High-risk patients receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with >90% resection goal, radiation, immunotherapy, and potentially retinoic acid therapy" — Daniel von Allmen (guideline) [Ep 1 · 6:06](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=366)
- "Intermediate risk tumors receive varying cycles of chemotherapy based on biologic risk factors" — Daniel von Allmen (guideline) [Ep 1 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "For intermediate risk tumors, the surgical goal is at least 50% response from initial primary tumor volume combining neoadjuvant chemotherapy and surgical resection" — Daniel von Allmen (guideline) [Ep 1 · 6:51](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "Low risk patients, depending on age and diagnosis timing, could be followed with observation alone" — Daniel von Allmen (guideline) [Ep 1 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "A Children's Oncology Group study led by Jed Nocturne showed patients less than six months with prenatally or early postnatally diagnosed localized mass can be observed with expectation that most will avoid surgery" — Daniel von Allmen (guideline) [Ep 1 · 7:22](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "Patients with metastatic disease typically receive four or five cycles of neoadjuvant chemotherapy and are then reassessed" — Daniel von Allmen (guideline) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If metastatic disease is responding to chemotherapy, the primary tumor site should be resected with attempted >90% resection" — Daniel von Allmen (guideline) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If metastatic disease is progressing on chemotherapy, surgery is not indicated" — Daniel von Allmen (guideline) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "MS disease is for patients less than 18 months with primary site and metastases to liver, skin, or bone marrow (specifically not cortical bone)" — Daniel von Allmen (guideline) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "MS disease patients can be managed with simple observation; treatment is only elected if they progress or develop complications like respiratory issues from enlarging liver mass" — Daniel von Allmen (guideline) [Ep 1 · 7:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "Skin lesions in MS disease can be biopsied to provide diagnosis" — Daniel von Allmen (clinical) [Ep 1 · 8:55](https://library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=535)
- "Adrenal hemorrhage is the most common prenatal suprarenal mass, more common with history of fetal stress" — Daniel von Allmen (clinical) [Ep 2 · 2:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=120)
- "Familial neuroblastoma occurs in about 1% of patients" — Tony Sandler (epidemiological) [Ep 2 · 3:27](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=207)
- "The GetNucturne study showed that many prenatally diagnosed neuroblastomas can be safely observed without surgery" — Daniel von Allmen (clinical) [Ep 2 · 7:24](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=444)
- "Of 84 prenatally diagnosed cases observed in the GetNucturne study, 16 (about 20%) underwent resection, with 98% event-free survival and 100% overall survival" — Tony Sandler (clinical) [Ep 2 · 9:09](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=549)
- "Surveillance for prenatally diagnosed neuroblastoma is intensive in the first year with ultrasound and urine catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out" — Erika Newman (guideline) [Ep 2 · 9:58](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=598)
- "A case occurred where a prenatally diagnosed adrenal mass resolved but the child presented at age 3 with widely metastatic high-risk neuroblastoma" — Daniel von Allmen (clinical) [Ep 2 · 10:23](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=623)
- "Five centimeters is used as a size threshold for considering surgical resection of observed neuroblastoma" — Tony Sandler (opinion) [Ep 2 · 12:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=751)
- "A 50% increase in tumor volume or 50% increase in urine VMA or HVA prompts consideration of surgery" — Erika Newman (guideline) [Ep 2 · 13:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=800)
- "Lymph node status in neuroblastoma is not as important for changing therapy as it is in Wilms tumor" — Daniel von Allmen (clinical) [Ep 2 · 14:21](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=861)
- "Stage MS (formerly 4S) neuroblastoma with liver metastases can cause respiratory compromise from mass effect" — Erika Newman (clinical) [Ep 2 · 15:14](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=914)
- "Stage MS neuroblastoma can be treated with aggressive observation, chemotherapy, radiation, or emergent decompressive laparotomy if respiratory compromise occurs" — Erika Newman (clinical) [Ep 2 · 15:42](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=942)
- "Classic findings of stage MS include high urine catecholamines, blue blebs on skin, liver metastases, and adrenal mass" — Tony Sandler (clinical) [Ep 2 · 16:32](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=992)
- "NMYC amplification in stage MS changes classification from MS to M (stage 4) and makes it high-risk" — Erika Newman (clinical) [Ep 2 · 17:32](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1052)
- "Ten percent of neuroblastomas are not MIBG-avid and might be detected by PET scan" — Daniel von Allmen (clinical) [Ep 2 · 22:12](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1332)
- "Open biopsy allows adequate tissue for NMYC amplification, ALK mutation, and ploidy studies" — Tony Sandler (clinical) [Ep 2 · 23:50](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1430)
- "Approximately half of children's hospitals use percutaneous biopsy for suspected neuroblastoma" — Erika Newman (epidemiological) [Ep 2 · 26:56](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1616)
- "Percutaneous biopsy is equivalent to open biopsy for diagnosis, high versus low risk determination, and NMYC amplification, but falls short for determining 11q loss of heterozygosity" — Erika Newman (clinical) [Ep 2 · 28:10](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1690)
- "Optimizing percutaneous biopsy requires 10-12 cores, higher gauge needle, and pathologist performing frozen section to confirm viable tumor" — Erika Newman (clinical) [Ep 2 · 29:10](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1750)
- "Open biopsy patients had higher risk of blood transfusion, higher narcotic use, and more hospital admissions compared to percutaneous biopsy" — Erika Newman (clinical) [Ep 2 · 30:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1817)
- "NMYC amplification automatically makes neuroblastoma high-risk regardless of other factors" — Tony Sandler (clinical) [Ep 2 · 31:38](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=1898)
- "Loss of heterozygosity at 11q is the most common segmental chromosomal alteration and can bump NMYC non-amplified patients to high or intermediate risk" — Erika Newman (clinical) [Ep 2 · 33:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2029)
- "Age cutoff for risk stratification is now 18 months rather than 12 months" — Tony Sandler (guideline) [Ep 2 · 35:25](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2125)
- "High-risk neuroblastoma patients require double lumen external central line for bone marrow transplant" — Erika Newman (clinical) [Ep 2 · 37:20](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2240)
- "Stem cell harvesting for high-risk neuroblastoma is usually after the second cycle of chemotherapy" — Tony Sandler (clinical) [Ep 2 · 45:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- "Optimal timing for surgical resection is after cycle 3-4 of induction chemotherapy" — Erika Newman (opinion) [Ep 2 · 41:49](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2509)
- "Tumor volume does not significantly decrease after cycle 2-3 of chemotherapy" — Daniel von Allmen (clinical) [Ep 2 · 43:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- "After 5-6 cycles of chemotherapy, tumors become more fibrotic and harder to resect" — Erika Newman (clinical) [Ep 2 · 43:17](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- "Goal of surgery is greater than 90% tumor resection based on COG study showing improved event-free survival" — Daniel von Allmen (clinical) [Ep 2 · 44:04](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2644)
- "European neuroblastoma group study of nearly 1000 cases showed >90% resection improved both event-free and overall survival" — Daniel von Allmen (clinical) [Ep 2 · 45:28](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- "About 70% of patients can achieve greater than 90% resection" — Daniel von Allmen (epidemiological) [Ep 2 · 45:28](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- "High-risk neuroblastoma responds well to chemotherapy due to high proliferative rate" — Tony Sandler (clinical) [Ep 2 · 45:31](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- "Recent German/European publication stated that amount of local disease resection does not make a difference in outcome" — Tony Sandler (clinical) [Ep 2 · 46:00](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2760)
- "Patients with high-risk neuroblastoma die of systemic metastatic disease, not local disease" — Tony Sandler (clinical) [Ep 2 · 46:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2800)
- "Good local control is achieved with combination of radiation and aggressive surgery" — Daniel von Allmen (clinical) [Ep 2 · 47:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=2860)
- "There is zero correlation between surgeon's operative note description of resection extent and post-operative imaging findings" — Daniel von Allmen (clinical) [Ep 2 · 52:19](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3139)
- "Surgeons frequently overestimate the amount of tumor resection achieved" — Daniel von Allmen (opinion) [Ep 2 · 52:19](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3139)
- "Nephrectomy should be avoided in neuroblastoma surgery because it requires reduction of chemotherapy doses" — Tony Sandler (clinical) [Ep 2 · 53:13](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3193)
- "Monoclonal antibody against ganglioside GD2 improved two-year survival in high-risk neuroblastoma from 46% to 60%" — Tony Sandler (clinical) [Ep 2 · 53:44](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3224)
- "Checkpoint inhibitors have not been successful in neuroblastoma because it is not an immunogenic tumor" — Tony Sandler (clinical) [Ep 2 · 54:40](https://library.globalcastmd.com/watch/neuroblastoma-1620?t=3280)

## Changelog
- Aug 31: 7 doctors auto-found from episode dossiers
- Aug 30: 2 doctors auto-found from episode dossiers
- Aug 30: 2 doctors auto-found from episode dossiers
- Aug 30: Members-only episodes removed from this collection
- Aug 29: 2 doctors auto-found from episode dossiers
- Aug 29: 2 doctors auto-found from episode dossiers
- Aug 29: Collection generated from campaign corpus: 6 items, 3 dossiers, summaries for 0 audience(s)
- Aug 29: Collection reviewed and published
- Aug 29: Collection generated from campaign corpus: 3 items, 3 dossiers, summaries for 1 audience(s)
- Aug 29: Collection generated from campaign corpus: 3 items, 3 dossiers, summaries for 2 audience(s)
- Aug 29: Collection generated from campaign corpus: 3 items, 3 dossiers, summaries for 0 audience(s)

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Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://library.globalcastmd.com/ai