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Undifferentiated Metastatic Neuroblastoma

View larger version (113K): [in this window] [in a new window]   Figure 1. 13-year-old AAF presented with a right arm mass. CT scans showed multiple hypolucent lesions in liver, ribs, sternum and mediatinal lymph nodes. A touch prep of the marrow biopsy shows a monomorphic infiltrate of medium-sized cells with minimal cytoplasm and slightly irregular nuclei. Normal hematopoietic elements are not identified.

View larger version (137K): [in this window] [in a new window]   Figure 2. A higher power view of the previous slide shows the cells to have variable amounts of basophilic cytoplasm, and round to notched nuclei of variable size, but nucleoli are not evident.

View larger version (84K): [in this window] [in a new window]   Figure 3. In another area of the touch prep a group of cohesive cells are noted almost forming a three-dimensional structure consistent with a non-hematopoietic infiltrate.

View larger version (72K): [in this window] [in a new window]   Figure 4. A higher power view of the cohesive cell group is shown. Individual cells have deeply basophilic cytoplasm with the appearance of fusing of the cell cytoplasms. Nuclear molding is evident.

View larger version (145K): [in this window] [in a new window]   Figure 5. A low power view of the marrow biopsy shows two distinct morphologic areas. The left half has a pale appearance with extensive serous atrophy and few scattered cells present. On the right half, groups of monomorphic cells are present in distinct lobular groups with extensive hemorrhage present in the venous sinuses.

View larger version (182K): [in this window] [in a new window]   Figure 6. Complete occlusion of vessels by thrombus is shown. This accounts for the area of marrow infarction that is present. Ghost cells are readily seen along with some residual viable cells (dark nuclei).

View larger version (169K): [in this window] [in a new window]   Figure 7. A higher power view of the previous image shows the thrombosed blood vessel. Cytoplasmic and nuclear outlines can be seen in some of the non-viable cells. Interspersed among these cells are other cells showing a spectrum of apoptotic changes.

View larger version (172K): [in this window] [in a new window]   Figure 8. The variation in stages of cellular death can be seen in greater detail in this view of the infarcted marrow.

View larger version (176K): [in this window] [in a new window]   Figure 9. The metastatic cells in this view can be seen forming a nodular pattern of infiltration, with septa separating the nodules. Glandular formation, however, can not be seen. There is hemorrhage throughout the nodules.

View larger version (170K): [in this window] [in a new window]   Figure 10. At a higher power view, the cells are adherent, a characteristic of a non-hematopoietic infiltrate. Multiple mitotic figures can be seen throughout in addition to apoptotic cells. Glanular structures (rosettes) with a lumen are suggested in several areas of the image.

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazarchick, J. Search for Related Content PubMed Articles by Lazarchick, J. Related Collections Bone marrow manifestations of inflammatory or other systemic (non-infectious disease) Related ASH-SAP Chapter Related Image Bank Image Sets Social Bookmarking                   What's this?