Xue-song Feng¹, Hui-xun Takagi, Ji-ru Feng*
We present a boy of 16 years diagnosed as an isolated bilateral neuroblastoma in an ectopic adrenal gland, an unusual cause of peritoneal ascites. He was complaining of severe abdominal pain over four months prior, with no other related symptoms. On physical examination, his weight and height were below expected for age, characterized by abdominal distension without hepatomegaly nor splenomegaly. There was a shifting dullness on his abdomen. No abdominal mass was palpable. Laboratory findings demonstrated the following: normochromic normocytic anemia, hemoglobin concentration of 9 g/dL, hematocrit concentration of 28.2%, leukocytes within the normal range, and platelet count within the normal range, total serum protein level of 6.7 g/dL, albumin level of 3.9 g/dL, an elevated C-reactive protein level of 28 mg/L (normal range <5 mm/h), and an elevated erythrocyte sedimentation rate of 73 mm/h. Both the serum lactate dehydrogenase and 24-hour urinary vanillylmandelic acid levels were elevated (2136 IU/L [normal range <480 mg/L] and 168.3 mg/day [normal range 0.8–6.4 mg/24 h], respectively). The patient's alpha-fetoprotein level was within the normal range. He underwent an abdominopelvic computed tomography scan with contrast medium that demonstrated a small amount of peritoneal effusion, cirrhotic liver, splenomegaly, mild retraction and calcification of gallbladder, and small lymph nodes in the peripancreatic and hepatic pedicle areas. Exploratory laparoscopy was performed owing to his unexplained ascites. There was mild peritoneal ascites approximately 50 mL in volume; volume replacement was performed with peritoneovenous shunt surgery. A totally retroperitoneally placed bilateral suprarenal rounded mass was also observed; some nodules in the liver and perihilar lymph node in the hepatoduodenal ligament and behind the common bile duct were considered metastases. A pheochromocytoma or a neuroblastoma was suggested.
Keywords: Neuroblastoma; Ascites; Pleural effusion
Copyright © 2020 by The American Society for BioMedicine and BM-Publisher, Inc.
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Case Report
DOI: http://dx.doi.org/10.18081/2333-5106/017-4/170-182
American Journal of BioMedicine Volume 8, Issue 4, pages 225-234
Received June 24, 2020; Accepted September 02, 2020; Published October 04, 2020