Massive hepatomegaly in a neonate: an unusual cause

Ritika Khurana, Anju Aggarwal, Aashima Dabas, Natasha Gupta


A female neonate presented with progressive abdominal distension. Liver was palpable, 11 cm below costal margin and a spleen of 10 cm. USG abdomen revealed massive hepatomegaly with multiple nodules in liver, kidney size and texture being normal. Contrast enhanced CT scan of the abdomen was suggestive of enlarged multinodular liver with splenomegaly. Liver biopsy revealed replacement of liver architecture by small rounded cells, which were positive for synaptophysin and S100 stains suggestive of neuroblastoma. A repeat abdominal radiological evaluation revealed a small 2 x 1 cm mass in left suprarenal area. Neuroblastoma stage 4S presenting as hepatomegaly is rare.


Hepatomegaly, Neonate, Neuroblastoma 4S

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Cohn SL, Pearson AD, London WB, Monclair T, Ambros PF, Brodeur GM, et al. The International neuroblastoma risk group (INRG) classification system: an INRG task force report. J Clin Oncol. 2009;27(2):289-97.

Gupta R, Mala TA, Mathur P, Paul R, Mala SA. Stage 4S bilateral adrenal neuroblastoma in a newborn. APSP J Case Rep. 2014;5(1):9.

Zage PE, Ater JL. Neuroblastoma. Nelson Textbook of Pediatrics. Kliegman RM(Ed). Elsevier. Philadelphia. 20th ed.; 2015:2461-4.

Okoji GO, Dotollo RA. Massive hepatomegaly in a 6-week-old infant: is it neuroblastoma? Ann Trop Paediatr. 1994;14(4):337-41.

Guglielmi M, De Bernardi B, Rizzo A. Resection of primary tumor at diagnosis in stage IV-S neuroblastoma: does it affect the clinical course? J Clin Oncol. 1996;14:1537-44.

Blatt J, Deutsch M, Wollman MR. Results of therapy in stage IV-S neuroblastoma with massive hepatomegaly. Int J Radiat Oncol Biol Phys. 1987;13:1467-71.

Boztug K, Kiely E, Roebuck DJ, Gaze M, Begent J, Brock P, et al. Successful treatment of MYCN amplified, progressive stage 4S neuroblastoma in a neonate with hepatic artery embolization in addition to multimodality treatment. Pediatr Blood Cancer. 2006;46(2):253-7.

Monclair T, Brodeur GM, Ambros PF, Brisse HJ, Cecchetto G, Holmes K, et al. The International neuroblastoma risk group (INRG) staging system: an INRG task force report. J Clin Oncol. 2009;27:298-303.