# Adrenal Tumors — GCMD Library living collection

Also covered as: neuroblastoma

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

Updated: n/a · 3 episodes · 105 cited statements

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

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

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

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=0) Introduction and Background (Ep 3)
- [2:29](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=149) Initial Evaluation of Thyroid Nodules (Ep 3)
- [6:56](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=416) Laboratory and Imaging Workup (Ep 3)
- [9:26](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=566) Ultrasound Characteristics and Biopsy Criteria (Ep 3)
- [11:40](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=700) FNA Technique and Papillary Cancer Diagnosis (Ep 3)
- [14:17](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=857) Surgical Management of Papillary Thyroid Cancer (Ep 3)
- [17:40](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1060) Postoperative Management and Risk Stratification (Ep 3)
- [21:48](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1308) Follicular Lesions and Indeterminate Cytology (Ep 3)
- [24:39](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1479) Frozen Section and Follicular Cancer Management (Ep 3)
- [27:53](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1673) Benign Nodules and Inadequate Specimens (Ep 3)
- [30:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1808) Medullary Thyroid Cancer: Initial Workup (Ep 3)
- [35:20](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2120) MEN Syndromes and Prophylactic Thyroidectomy (Ep 3)
- [39:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2367) Medullary Cancer: Postoperative Management (Ep 3)
- [41:59](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2519) Graves' Disease and Diffuse Papillary Cancer (Ep 3)
- [44:23](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2663) Closing Remarks (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=0) Introduction and Prenatal Diagnosis Approach (Ep 2)
- [4:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=240) Postnatal Workup and Observation Strategy (Ep 2)
- [9:07](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=547) Surveillance Protocol and Long-term Follow-up (Ep 2)
- [11:03](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=663) Surgical Approach and Stage MS Disease (Ep 2)
- [14:44](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=884) Workup of Older Child with Abdominal Mass (Ep 2)
- [21:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1310) Tissue Biopsy Techniques and Adequacy (Ep 2)
- [30:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1817) Risk Stratification and Staging (Ep 2)
- [36:54](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2214) Central Line Selection and Timing (Ep 2)
- [41:49](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2509) Timing of Surgical Resection (Ep 2)
- [47:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2860) Surgical Philosophy and Extent of Resection (Ep 2)
- [53:13](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3193) Immunotherapy Advances (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0) Introduction and Overview (Ep 1)
- [0:38](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=38) Clinical Presentation and Initial Workup (Ep 1)
- [2:11](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=131) MIBG Accuracy and Pre-Biopsy Staging (Ep 1)
- [3:53](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=233) Surgical Approach for Localized Disease (Ep 1)
- [5:08](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=308) Biopsy Results and Risk Stratification (Ep 1)
- [6:48](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=408) Treatment for Intermediate and Low Risk Disease (Ep 1)
- [7:50](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=470) Management of Metastatic and MS Disease (Ep 1)
- [9:00](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=540) Clinical Pearls and Conclusion (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://qa.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://qa.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://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=248)
- "Some thyroid conditions and thyroid cancers have familial predisposition, including MEN syndromes, PTEN hamartoma tumor syndromes, and APC-associated polyposis syndromes." — Diana Deason (clinical) [Ep 3 · 4:27](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=267)
- "If TSH is suppressed, a nuclear thyroid scan should be obtained to identify hyperfunctioning nodules, which do not need to be biopsied if they are going to be resected." — Diana Deason (guideline) [Ep 3 · 7:24](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=444)
- "Suspicious ultrasound features for thyroid malignancy include hypoechoic mass, irregular margins, increased blood flow, microcalcifications, or association with abnormal lymph nodes." — Diana Deason (clinical) [Ep 3 · 9:57](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=597)
- "In pediatric patients, size cutoffs used in adults (1 cm) cannot be applied for biopsy decisions; ultrasound characteristics and clinical context determine whether FNA is warranted." — Diana Deason (guideline) [Ep 3 · 11:21](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=681)
- "Total or near-total thyroidectomy is recommended for papillary thyroid cancer due to risk of bilateral disease (up to 30%), multifocal disease (up to 65%), increased risk of recurrence with lobectomy alone, and ability to optimize for radioactive iodine and use thyroglobulin as a tumor marker." — Diana Deason (guideline) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=900)
- "Nerve monitoring is used routinely during thyroidectomy, and while it does not decrease the 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://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1027)
- "There is no evidence to support prophylactic lateral neck dissection in thyroid cancer; lateral neck dissection is performed only when lateral nodes are pathologically positive." — Diana Deason (guideline) [Ep 3 · 18:33](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1113)
- "After total thyroidectomy, PTH levels less than 10 to 15 in recovery indicate higher risk for hypocalcemia, prompting initiation of calcium replacement or calcitriol." — Diana Deason (clinical) [Ep 3 · 19:37](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1177)
- "Low-risk papillary thyroid cancer patients (disease confined to thyroid, no nodal involvement, T1B N0) require only thyroglobulin surveillance with TSH suppression to 0.5-1, ultrasound at 6 months postoperatively, then annually for 5 years." — Diana Deason (guideline) [Ep 3 · 21:12](https://qa.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 metastases) may require radioactive iodine postoperatively." — Diana Deason (guideline) [Ep 3 · 21:48](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1308)
- "Follicular lesions represent about one-third of thyroid FNA results and are indeterminate specimens." — Diana Deason (epidemiological) [Ep 3 · 23:05](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1385)
- "For follicular lesions of undetermined significance, the risk of malignancy in adults is 5-15%, but in pediatric literature it is approximately 28%." — Diana Deason (epidemiological) [Ep 3 · 24:07](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1447)
- "For follicular neoplasms, the reported malignancy rate was 15-30%, but more recent data suggests it is between 50% and 60% in children." — Diana Deason (epidemiological) [Ep 3 · 24:18](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1458)
- "Current ATA recommendations are that all indeterminate (follicular) lesions in children be resected, typically with lobectomy and removal of the isthmus." — Diana Deason (guideline) [Ep 3 · 23:50](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1430)
- "Frozen section cannot distinguish follicular adenoma from follicular carcinoma, but can identify papillary components." — Diana Deason (clinical) [Ep 3 · 25:04](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1504)
- "For follicular carcinoma with significant vascular invasion or tumor greater than 4 cm, completion thyroidectomy is recommended; smaller tumors with minimal vascular invasion can be monitored." — Diana Deason (guideline) [Ep 3 · 26:10](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1570)
- "About 30% of patients who undergo lobectomy may develop hypothyroidism at some point, so thyroid function monitoring is important even after partial thyroidectomy." — Diana Deason (epidemiological) [Ep 3 · 27:01](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1621)
- "TSH suppression goals vary by ATA pediatric risk level: low-risk patients have a TSH goal of 0.5-1, while high-risk patients have a TSH goal of less than 0.1." — Diana Deason (guideline) [Ep 3 · 27:31](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1651)
- "For benign thyroid nodules greater than 4 cm, the sensitivity and specificity of FNA is decreased, so it is important to follow these lesions with repeat ultrasound in 6-12 months and repeat biopsy if enlarging or developing suspicious features." — Diana Deason (clinical) [Ep 3 · 28:49](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1729)
- "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 the initial FNA." — Diana Deason (clinical) [Ep 3 · 29:49](https://qa.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 child with a thyroid nodule." — Diana Deason (guideline) [Ep 3 · 31:34](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=1894)
- "For medullary thyroid cancer, if initial calcitonin level is greater than 500, imaging should be performed to exclude metastatic disease, including CT of neck and chest, MRI or CT of abdomen (looking at liver), and bone scan." — Diana Deason (guideline) [Ep 3 · 33:01](https://qa.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://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2016)
- "MEN 2B patients can develop medullary thyroid cancer, pheochromocytomas, mucosal neuromas, and a Marfanoid habitus with elongated features and joint laxity." — Diana Deason (clinical) [Ep 3 · 33:47](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2027)
- "MEN 2B patients with RET 918 mutation present with thyroid cancer very early, as young as 3 months of age, and require thyroidectomy before 1 year of age." — Diana Deason (guideline) [Ep 3 · 34:11](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2051)
- "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; if calcitonin or ultrasound abnormalities develop, thyroidectomy should be performed at that time." — Diana Deason (guideline) [Ep 3 · 36:03](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2163)
- "If calcitonin levels exceed 40 in MEN patients undergoing surveillance, central neck dissection is recommended at the time of thyroidectomy." — Diana Deason (guideline) [Ep 3 · 36:27](https://qa.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 and smaller parathyroid glands." — Diana Deason (clinical) [Ep 3 · 36:52](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2212)
- "For MEN 2A moderate-risk patients, total thyroidectomy is recommended when serum calcitonin becomes elevated or if parents do not want to proceed with frequent surveillance." — Diana Deason (guideline) [Ep 3 · 36:59](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2219)
- "MEN 2A moderate-risk patients do not tend to develop pheochromocytomas until their twenties or above, so screening begins at age 16; MEN 2A high-risk patients begin pheochromocytoma screening at age 11." — Diana Deason (guideline) [Ep 3 · 37:47](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2267)
- "For prophylactic thyroidectomy in MEN patients, if performed before calcitonin levels exceed 40, central lymph node dissection is not necessary." — Diana Deason (guideline) [Ep 3 · 39:03](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2343)
- "After thyroidectomy for medullary cancer, if calcitonin levels are undetectable or normal, surveillance includes physical exam and neck ultrasounds every 6 months for 1 year, then annually." — Diana Deason (guideline) [Ep 3 · 40:08](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2408)
- "If postoperative calcitonin levels are greater than 150, imaging should be performed to detect metastasis, including CT neck and chest, MRI or CT abdomen, bone scan, and MRI of pelvis and axial skeleton." — Diana Deason (guideline) [Ep 3 · 40:22](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2422)
- "Systemic therapy for medullary thyroid cancer (tyrosine kinase inhibitors, external beam radiation) has significant side effects and is reserved for patients with progressive disease not treatable with surgery, not for all patients with elevated calcitonin." — Diana Deason (guideline) [Ep 3 · 41:38](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2498)
- "For Graves' disease in young children, thyroidectomy 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://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2549)
- "Some pediatric patients with papillary thyroid cancer present with diffuse infiltration of the thyroid rather than a discrete nodule, often with clinically suspicious lymph nodes, which is a characteristic more common in children." — Diana Deason (clinical) [Ep 3 · 43:52](https://qa.library.globalcastmd.com/watch/thyroid-disorders-302?t=2632)
- "Neuroblastoma is the most common extracranial solid tumor in children, with the majority occurring in children less than a year old." — Rae Hanke (host_summary) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=0)
- "In younger patients, neuroblastoma is often picked up either prenatally on ultrasound, or in younger kids (two-year-old or three-year-old) as a solid abdominal mass." — Daniel von Allmen (clinical) [Ep 1 · 0:41](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "When neuroblastoma patients have metastatic disease, they may present with either bony pain or potentially neurologic symptoms from cord compression." — Daniel von Allmen (clinical) [Ep 1 · 0:41](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=41)
- "When considering neuroblastoma as part of the differential diagnosis, it is important to get catecholamines (either urine or serum) as one of the most diagnostic laboratory tests for this tumor." — Daniel von Allmen (clinical) [Ep 1 · 1:07](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=67)
- "Most children with suspected neuroblastoma would get a cross-sectional imaging study, either a CT scan or an MRI." — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "If imaging suggests neuroblastoma (central abdominal mass or adrenal mass rather than kidney mass), the next test would be a nuclear medicine study, typically an MIBG study." — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=99)
- "The MIBG study is helpful for confirming the diagnosis of neuroblastoma and can also demonstrate metastatic disease." — Daniel von Allmen (clinical) [Ep 1 · 1:39](https://qa.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://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "Some centers, including Cincinnati Children's Hospital, would get a PET scan looking for tumor uptake as well as potential metastatic disease." — Daniel von Allmen (clinical) [Ep 1 · 2:20](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=140)
- "Based on the most recent iteration of the neuroblastoma staging system (INRGSS), it is possible to assign a stage before any invasive procedure is performed." — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "In the INRGSS system, tumors that are localized are categorized as L1; if localized but have image-defined risk factors (encasing nerves or vessels), they are L2; if they have metastatic disease, they are M." — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "There is a special category MS for children less than 18 months of age who have metastases to either the bone marrow or the skin." — Daniel von Allmen (guideline) [Ep 1 · 2:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=165)
- "The INRGSS pre-biopsy staging system was specifically created to allow studies from different centers in different countries to be compared based on the pre-surgical staging of the patient." — Daniel von Allmen (guideline) [Ep 1 · 3:36](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "The prior neuroblastoma staging system required tissue diagnosis before assigning a stage." — Daniel von Allmen (guideline) [Ep 1 · 3:36](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=216)
- "A child with an adrenal mass on the right side and a positive MIBG scan but no evidence of metastases could potentially be treated with a primary resection of the mass via laparotomy." — Daniel von Allmen (clinical) [Ep 1 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- "Some surgeons would approach resection of a localized neuroblastoma with laparoscopy depending on the size of the tumor." — Daniel von Allmen (opinion) [Ep 1 · 4:06](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=246)
- "For very large masses that encase the aorta, cava, or other major vasculature, all you really want is tissue for diagnosis, which can be obtained through open biopsy, laparoscopic biopsy, or core needle biopsies done by an interventional radiologist." — Daniel von Allmen (clinical) [Ep 1 · 4:44](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=284)
- "The most important biologic risk determinant to obtain from neuroblastoma biopsy tissue is the NMIC status." — Daniel von Allmen (clinical) [Ep 1 · 5:14](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "In addition to NMIC status, you want to look for 1P and 11Q deletions and Shimada histology in neuroblastoma biopsy tissue." — Daniel von Allmen (clinical) [Ep 1 · 5:14](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=314)
- "Biologic risk determinants from biopsy will tell you what risk category the patient falls into: very low risk, low risk, intermediate risk, or high risk." — Daniel von Allmen (clinical) [Ep 1 · 5:45](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=345)
- "Neuroblastoma risk is divided about 50-50 between the low risk categories and the high risk category, with a smaller percentage being intermediate risk." — Daniel von Allmen (epidemiological) [Ep 1 · 5:45](https://qa.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 · 6:11](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- "Patients with high risk neuroblastoma receive aggressive chemotherapy including peripheral stem cell transplant times 2, aggressive surgery with the goal of greater than 90% resection of the tumor, followed by radiation, immunotherapy after chemotherapy, and potentially retinoic acid therapy." — Daniel von Allmen (clinical) [Ep 1 · 6:11](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=371)
- "Intermediate risk neuroblastoma tumors get varying cycles of chemotherapy based on the biologic risk factors they have." — Daniel von Allmen (clinical) [Ep 1 · 6:51](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "For intermediate risk neuroblastoma, the goal at the time of debulking or resecting the primary tumor is to achieve at least a 50% response from the initial volume of the primary tumor through the combination of neoadjuvant chemotherapy and surgical resection." — Daniel von Allmen (clinical) [Ep 1 · 6:51](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=411)
- "The low risk neuroblastoma group, depending on the actual age of the patient and how it is diagnosed, could potentially be followed simply with observation." — Daniel von Allmen (clinical) [Ep 1 · 7:22](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "Jed Nocturne led a study through the Children's Oncology Group looking at patients less than six months of age with either a prenatally diagnosed or shortly postnatally diagnosed localized mass, showing these patients can be observed with the expectation that the vast majority will avoid any type of surgical procedure." — Daniel von Allmen (clinical) [Ep 1 · 7:22](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=442)
- "Patients with metastatic neuroblastoma typically receive four or five cycles of neoadjuvant chemotherapy and then are reassessed." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If the tumor and metastatic disease are responding to neoadjuvant chemotherapy, one would attack the primary tumor site with a resection, with many advocating for attempting a greater than 90% resection." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If the metastatic disease is progressing on neoadjuvant chemotherapy, then surgery is not indicated." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "MS disease is specifically for patients who have a primary site with metastatic disease to the liver, the skin, or the bone marrow (specifically not bone, not cortical bone) and is less than 18 months of age." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "In patients with MS disease, simple observation can be the treatment path." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "If MS disease patients progress or develop respiratory issues because of an enlarging liver mass, treatment might be elected because of the complication of the size of the tumor, but the tumor itself usually does not have to be treated." — Daniel von Allmen (clinical) [Ep 1 · 7:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=475)
- "You can biopsy the skin lesions in MS disease and that will give you the diagnosis." — Daniel von Allmen (clinical) [Ep 1 · 8:55](https://qa.library.globalcastmd.com/watch/topics-in-10-neuroblastoma-1659?t=535)
- "Adrenal hemorrhage is the most common cause of prenatal suprarenal mass, especially with history of fetal stress" — Daniel von Allmen (clinical) [Ep 2 · 2:00](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=120)
- "Familial neuroblastoma occurs in approximately 1% of patients" — Tony Sandler (epidemiological) [Ep 2 · 3:27](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=207)
- "The GetNucturne study showed that prenatal/neonatal neuroblastomas can be safely observed with careful ultrasound surveillance, with many patients spared surgery" — Daniel von Allmen (clinical) [Ep 2 · 7:24](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=444)
- "In the GetNucturne observation study of 84 patients, 16 (approximately 20%) underwent resection for growth or family preference, with 98% event-free survival and 100% overall survival" — Tony Sandler (clinical) [Ep 2 · 9:09](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=549)
- "Surveillance protocol for observed neonatal masses: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spacing out through first year, then every 6 months, then yearly" — Erika Newman (guideline) [Ep 2 · 9:58](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=598)
- "Criteria for surgery in observed neonatal neuroblastoma: >50% volume increase or >50% increase in VMA or HVA" — Erika Newman (guideline) [Ep 2 · 13:20](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=800)
- "Five centimeters is the size cutoff where most experts recommend surgical resection of neonatal neuroblastoma" — Tony Sandler (opinion) [Ep 2 · 12:43](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=763)
- "Lymph node status in neuroblastoma does not change therapy, unlike Wilms tumor" — Daniel von Allmen (clinical) [Ep 2 · 14:21](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=861)
- "Stage MS (formerly 4S) neuroblastoma with liver and skin metastases in neonates has good biology and can be observed unless respiratory compromise develops from hepatomegaly" — Erika Newman (clinical) [Ep 2 · 14:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=890)
- "Treatment options for MS neuroblastoma with respiratory compromise include chemotherapy, radiation, or emergent decompressive laparotomy" — Erika Newman (clinical) [Ep 2 · 15:42](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=942)
- "Approximately 10% of neuroblastomas are not MIBG-avid, which is when PET scan may be useful" — Daniel von Allmen (clinical) [Ep 2 · 22:12](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1332)
- "Open biopsy via retroperitoneal approach allows adequate tissue for NMEC amplification, ALK mutation, ploidy, and 11q status" — Tony Sandler (clinical) [Ep 2 · 23:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1430)
- "Approximately 50% of children's hospitals now use percutaneous biopsy for suspected neuroblastoma" — Erika Newman (epidemiological) [Ep 2 · 26:56](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1616)
- "Percutaneous biopsy is equivalent to open biopsy for diagnosis and NMEC determination but may fail for 11q loss of heterozygosity assessment" — Erika Newman (clinical) [Ep 2 · 28:04](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1684)
- "Optimized percutaneous biopsy technique requires 10-12 cores, higher gauge needle, and pathologist present for frozen section to confirm viable tumor" — Erika Newman (clinical) [Ep 2 · 28:55](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1735)
- "Open biopsy patients have higher risk of blood transfusion, higher narcotic use, and more frequent hospital admission compared to percutaneous biopsy" — Erika Newman (clinical) [Ep 2 · 29:45](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1785)
- "NMEC amplification automatically means high-risk neuroblastoma regardless of other factors" — Tony Sandler (clinical) [Ep 2 · 31:38](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=1898)
- "Loss of heterozygosity at 11q is the most common segmental chromosomal alteration in neuroblastoma and can elevate risk category" — Erika Newman (clinical) [Ep 2 · 33:49](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2029)
- "Age cutoff for neuroblastoma risk stratification is 18 months (previously was 12 months)" — Tony Sandler (guideline) [Ep 2 · 35:25](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2125)
- "High-risk neuroblastoma patients require double-lumen external catheter (not port) for bone marrow transplant" — Erika Newman (clinical) [Ep 2 · 37:20](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2240)
- "Stem cell harvesting for high-risk neuroblastoma typically occurs after cycle 2 of chemotherapy" — Tony Sandler (clinical) [Ep 2 · 45:31](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2731)
- "Tumor shrinkage in neuroblastoma plateaus after cycle 2-3 of chemotherapy per LaQuaglia and Von Allman studies" — Daniel von Allmen (clinical) [Ep 2 · 43:17](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2597)
- "After 5-6 cycles of chemotherapy, neuroblastomas become more fibrotic and harder to resect" — Erika Newman (clinical) [Ep 2 · 42:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2560)
- "COG high-risk study showed >90% resection improved event-free survival but not overall survival (approximately 245 patients)" — Daniel von Allmen (clinical) [Ep 2 · 44:04](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2644)
- "European neuroblastoma group study (approximately 1000 cases) showed >90% resection improved both event-free survival and overall survival" — Daniel von Allmen (clinical) [Ep 2 · 45:28](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2728)
- "Approximately 70% of high-risk neuroblastoma patients can achieve >90% resection" — Daniel von Allmen (epidemiological) [Ep 2 · 46:10](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2770)
- "Recent German/European publication stated unequivocally that extent of resection does not make a difference in neuroblastoma outcomes" — Tony Sandler (clinical) [Ep 2 · 46:50](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2810)
- "High-risk neuroblastoma patients die of metastatic disease, not local disease recurrence" — Tony Sandler (clinical) [Ep 2 · 47:40](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=2860)
- "Neuroblastoma theoretically does not invade vessel adventitia, though invasion has been observed" — Daniel von Allmen (clinical) [Ep 2 · 50:54](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3054)
- "There is zero correlation between surgeon operative note description of resection extent and post-operative imaging findings" — Daniel von Allmen (clinical) [Ep 2 · 51:30](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3090)
- "Nephrectomy should be avoided in neuroblastoma resection because kidney removal requires chemotherapy dose reduction" — Tony Sandler (clinical) [Ep 2 · 53:13](https://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3193)
- "Anti-GD2 monoclonal antibody improved high-risk neuroblastoma two-year survival from 46% to 60%" — Tony Sandler (clinical) [Ep 2 · 53:44](https://qa.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://qa.library.globalcastmd.com/watch/neuroblastoma-1620?t=3280)

## Changelog
- Sep 9: Summaries and takeaways published for 4 audiences
- 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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