Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
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, Neuroblastoma · 9:58
Neuroblastoma
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Drs Erika Newman, Dan von Allmen and Tony Sandler join Dr. Todd Ponsky in a discussion covering the latest in neuroblastoma. Contributing editor: Rachel (Rae) Hanke, MD
Case 1: Mother who presents with 26 week fetus
with a pr
podcast56:19 · Dec 2020
Topics in 10: Neuroblastoma
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Drs Daniel von Allmen, Todd Ponsky and Rae Hanke come together to provide you the essentials on the diagnosis and management of Neuroblastoma. Intro and outro tracks are adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist U
podcast10:25 · Dec 2020
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, Neuroblastoma · 26:03
Neuroblastoma
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Dr. Daniel von Allmen, surgeon-in-chief at Cincinnati Children’s, joins Dr. Rae Hanke to review the essentials of neuroblastoma in this videocast.
video · May 2020
Did you Know: Storycasts
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Did you know we have all new interactive cases that we like to call "StoryCasts". It's like a choose your own adventure game but right here on your phone. Watch this video to learn how to use this new feature!
video · May 2021
Featured picks for families are being prepared — the summaries above are written for you.
Expert statements from the recordings in this collection.
Neuroblastoma
Adrenal hemorrhage is the most common differential diagnosis for prenatal suprarenal mass, more common with history of fetal stress
Daniel von Allmen2:11
Other differential diagnoses for suprarenal mass include neuroblastoma, pulmonary sequestration below the diaphragm, and misdiagnosed renal anomaly
Daniel von Allmen2:11
Familial neuroblastoma occurs in about 1% of patients
Tony Sandler4:39
For prenatal suprarenal mass, first postnatal study should be ultrasound of the abdomen
CT scan or MRI not needed for 3 cm lesion unless urine catecholamines are elevated
MIBG scan is the next step if catecholamines are elevated
Radiologists are quite good at identifying adrenal hemorrhage on ultrasound
In perinatal phase, most common metastatic sites are liver, bone, skin, and lymph nodes
Daniel von Allmen8:14
Nocktern study data supports observation of prenatal neuroblastoma with careful ultrasound surveillance
Of 84 observed patients in Nocktern study, 16 (approximately 20%) underwent resection for growth or family preference
Tony Sandler10:39
Nocktern study showed approximately 98% event-free survival and 100% overall survival in observed prenatal neuroblastoma
Erika Newman11:07
First-year surveillance protocol: ultrasound and catecholamines at birth, 3 weeks, 6 weeks, 12 weeks, then spaced out to one year
After one year, surveillance becomes every six months, then yearly
Case report: child with observed prenatal adrenal mass that resolved presented at age 3 with widely metastatic high-risk neuroblastoma
Daniel von Allmen12:27
5 centimeters is used as size cutoff for surgical intervention in observed prenatal masses
Volume increase of more than 50% is criterion for considering surgery
50% increase in VMA or HVA prompts consideration of surgery
Laparoscopic approach is reasonable for masses less than 6 centimeters
Lymph node status in neuroblastoma is not as important for therapy changes as in Wilms tumor
Daniel von Allmen16:36
Biology of neuroblastoma is more important than lymph node status for treatment decisions
Erika Newman17:00
Stage MS (formerly 4S) with skin lesions and liver mets still tends to have good biology
Erika Newman17:30
Primary concern in stage MS with liver involvement is mass effect causing respiratory compromise
Daniel von Allmen17:58
Stage MS without distress can be treated with aggressive observation
Once respiratory compromise begins, treatment options include chemotherapy, radiation, or emergent decompressive laparotomy
Classic findings of stage MS (high catecholamines, blue blebs on skin, liver metastasis, adrenal mass) may not require biopsy
Liver biopsy in newborns is difficult because bleeding is hard to control
Erika Newman19:52
If NMYC is amplified in stage MS, staging changes from MS to M
Todd Ponsky20:40
VIP secretion can cause severe diarrhea in neuroblastoma
Erika Newman21:05
Initial workup for abdominal mass includes ultrasound to determine solid vs cystic, then CT with PO and IV contrast if solid
Ultrasound is important for Wilms tumor to assess venous extension
Tony Sandler22:56