Dr. Daniel von Allmen, surgeon-in-chief at Cincinnati Children’s, joins Dr. Rae Hanke to review the essentials of neuroblastoma in this videocast.
Type: video · posted 2020-05-02 Canonical: https://library.globalcastmd.com/watch/neuroblastoma-2534 ## Chapters - [0:00](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=0) Prenatal Diagnosis and Observation - [10:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=639) Surveillance Protocol and Indications for Surgery - [15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908) Stage MS Disease with Liver Involvement - [21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265) Workup of Large Abdominal Mass in Older Child - [27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) Tissue Acquisition Strategies ## Statements - "Adrenal hemorrhage is the most common differential diagnosis for prenatal suprarenal mass, more common with history of fetal stress" — Daniel von Allmen (clinical) [2:11](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=131) - "Other differential diagnoses for suprarenal mass include neuroblastoma, pulmonary sequestration below the diaphragm, and misdiagnosed renal anomaly" — Daniel von Allmen (clinical) [2:11](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=131) - "Familial neuroblastoma occurs in about 1% of patients" — Tony Sandler (epidemiological) [4:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=279) - "For prenatal suprarenal mass, first postnatal study should be ultrasound of the abdomen" — Todd Ponsky (guideline) [5:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=307) - "CT scan or MRI not needed for 3 cm lesion unless urine catecholamines are elevated" — Tony Sandler (guideline) [5:34](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=334) - "MIBG scan is the next step if catecholamines are elevated" — Daniel von Allmen (guideline) [6:02](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=362) - "Radiologists are quite good at identifying adrenal hemorrhage on ultrasound" — Daniel von Allmen (opinion) [6:02](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=362) - "In perinatal phase, most common metastatic sites are liver, bone, skin, and lymph nodes" — Daniel von Allmen (clinical) [8:14](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=494) - "Nocktern study data supports observation of prenatal neuroblastoma with careful ultrasound surveillance" — Daniel von Allmen (guideline) [8:44](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=524) - "Of 84 observed patients in Nocktern study, 16 (approximately 20%) underwent resection for growth or family preference" — Tony Sandler (epidemiological) [10:39](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=639) - "Nocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma" — Erika Newman (epidemiological) [11:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=667) - "First-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year" — Erika Newman (guideline) [11:37](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=697) - "After one year, surveillance becomes every six months, then yearly" — Erika Newman (guideline) [11:37](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=697) - "Case report: child with observed prenatal adrenal mass that resolved presented at age 3 with widely metastatic high-risk neuroblastoma" — Daniel von Allmen (clinical) [12:27](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=747) - "5 centimeters is used as size cutoff for surgical intervention in observed prenatal masses" — Tony Sandler (guideline) [14:36](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=876) - "Volume increase of more than 50% is criterion for considering surgery" — Todd Ponsky (guideline) [15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908) - "50% increase in VMA or HVA prompts consideration of surgery" — Todd Ponsky (guideline) [15:08](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=908) - "Laparoscopic approach is reasonable for masses less than 6 centimeters" — Erika Newman (guideline) [16:07](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=967) - "Lymph node status in neuroblastoma is not as important for therapy changes as in Wilms tumor" — Daniel von Allmen (clinical) [16:36](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=996) - "Biology of neuroblastoma is more important than lymph node status for treatment decisions" — Erika Newman (clinical) [17:00](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1020) - "Stage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology" — Erika Newman (clinical) [17:30](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1050) - "Primary concern in stage MS with liver involvement is mass effect causing respiratory compromise" — Daniel von Allmen (clinical) [17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078) - "Stage MS without distress can be treated with aggressive observation" — Erika Newman (guideline) [17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078) - "Once respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy" — Erika Newman (guideline) [17:58](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1078) - "Classic findings of stage MS (high catecholamines, blue blebs on skin, liver metastasis, adrenal mass) may not require biopsy" — Daniel von Allmen (opinion) [19:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1146) - "Liver biopsy in newborns is difficult because bleeding is hard to control" — Erika Newman (clinical) [19:52](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1192) - "If NMYC is amplified in stage MS, staging changes from MS to M" — Todd Ponsky (clinical) [20:40](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1240) - "VIP secretion can cause severe diarrhea in neuroblastoma" — Erika Newman (clinical) [21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265) - "Initial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid" — Erika Newman (guideline) [21:05](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1265) - "Ultrasound is important for Wilms tumor to assess venous extension" — Tony Sandler (clinical) [22:56](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1376) - "Large mass encasing aorta and celiac axis with microcalcifications represents L2 INRG classification" — Tony Sandler (clinical) [23:50](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1430) - "Complete staging workup includes bone marrow biopsy, MIBG scan, chest CT to rule out metastasis, and head CT if clinical symptoms present" — Tony Sandler (guideline) [23:50](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1430) - "10% of neuroblastomas are not MIBG avid" — Daniel von Allmen (epidemiological) [25:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1506) - "PET scan may detect metastases in MIBG-negative neuroblastomas" — Daniel von Allmen (clinical) [25:06](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1506) - "PET scan is not part of routine initial diagnostic workup but may be used for MIBG-negative soft tissue areas to distinguish recurrence from scar" — Erika Newman (guideline) [26:03](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1563) - "Open retroperitoneal biopsy provides adequate tissue size for pathology and biology studies" — Tony Sandler (opinion) [27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "Transperitoneal laparoscopic biopsy may not allow adequate bleeding control for large tumors" — Tony Sandler (opinion) [27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "Multiple percutaneous biopsies may not provide adequate tissue for biology studies" — Tony Sandler (opinion) [27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "NMYC amplification can be obtained from bone marrow, but additional biology studies require tumor tissue" — Tony Sandler (clinical) [27:10](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1630) - "Biology studies beyond NMYC include ALK mutation and ploidy status" — Tony Sandler (clinical) [28:28](https://library.globalcastmd.com/watch/neuroblastoma-2534?t=1708) --- Not medical advice · citation policy: https://library.globalcastmd.com/ai