Boyd J E, Parmley R T, Langevin A M, Saldívar V A
Department of Pediatrics, University of Texas Health Science Center at San Antonio, USA.
J Pediatr Hematol Oncol. 1996 May;18(2):206-12. doi: 10.1097/00043426-199605000-00024.
We report a 5-year-old boy with stage 4 neuroblastoma initially diagnosed as having acute monoblastic leukemia (FAB M5A, AMoL), based on bone marrow morphology, histochemistry, immunocytochemistry, immunophenotyping and cytogenetics, all consistent with AMoL. The patient also had circulating blasts at diagnosis. After failing initial therapy for AMoL and because of concerns about residual blasts with a clumped appearance in the bone marrow, urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA) and N-myc amplification in tumor cells were evaluated and found to be positive, resulting in the diagnosis of neuroblastoma. Abdominal computerized tomography showed a left adrenal mass. A review of 10 reported cases of neuroblastoma with leukemic features showed that seven of them were misdiagnosed as having leukemia, and in six of the seven, the diagnosis of neuroblastoma was made postmortem.
Neuroblastoma may be confused with acute leukemia, even with the use of modern techniques.
我们报告一名5岁患有4期神经母细胞瘤的男孩，最初根据骨髓形态学、组织化学、免疫细胞化学、免疫表型分析和细胞遗传学诊断为急性单核细胞白血病（FAB M5A，急性单核细胞白血病），所有结果均与急性单核细胞白血病相符。该患者在诊断时也有循环原始细胞。在急性单核细胞白血病初始治疗失败后，由于担心骨髓中出现聚集外观的残留原始细胞，对尿高香草酸（HVA）、香草扁桃酸（VMA）和肿瘤细胞中的N - myc扩增进行了评估，结果呈阳性，从而诊断为神经母细胞瘤。腹部计算机断层扫描显示左肾上腺肿块。对10例报告的具有白血病特征的神经母细胞瘤病例进行回顾发现，其中7例被误诊为白血病，在这7例中的6例中，神经母细胞瘤的诊断是在尸检后做出的。
即使使用现代技术，神经母细胞瘤也可能与急性白血病混淆。
