A Swollen Eye? A Case of Rapidly Progressive Neuroblastoma

Clinical Laboratory Science, Summer 2004 by Spence, Libby, Gaskin, Susan L

An eight-month-old female was seen by her physician due to irritability and sleeplessness of several nights duration. No physical reason was detected for her discomfort. Two weeks later she returned with a swollen left eye. A CBC revealed a 14,600 WBC and low-grade anemia. She was then referred to a pediatric ophthalmologist who performed a CT scan of her head and a biopsy of a left peri-orbital tumor. The biopsy revealed a malignant neoplasm. The bone marrow showed tumor clumps. The laboratory values were consistent with a diagnosis of Stage IV neuroblastoma. Staging of the tumor along with biologic features determined treatment. The MYCN oncogene was not amplified and the DNA index was 1, indicating a poor prognosis. Chemotherapy was initiated, but biopsies showed progressive tumor involvement. Surgical interventions removed tissue and fluid from both eyes. She was hospitalized with respiratory distress due to mediastinal masses compressing the airway. Six weeks later she died. Neuroblastoma is a serious, rapidly developing cancer common in infants and young children. Because survival rates and recovery are dependent upon the stage and age at diagnosis, precise laboratory diagnostic tests are indispensable for providing information to physicians to aid in determining treatment and prognosis.

Libby Spence PhD CLS(NCA), Susan L Gaskin, University of Mississippi Medical Center, Jackson MS.