Neuroimaging Patterns of Central Nervous System Metastases in Neuroblastoma: Report of 2 Recent Cases and Literature Review

Abstract

The authors describe imaging patterns of intracranial metastases in 2 children with grade 4 neuroblastoma. Central nervous system metastases from neuroblastoma are extremely rare and may involve the cerebral parenchyma, leptomeninges, or dura. Cerebral parenchymal metastases can be cystic with mural nodules or solid with hemorrhagic elements. The first patient in our study had multiple cystic parenchymal metastases with calcific mural nodules, while the second patient developed solid hemorrhagic parenchymal metastatic lesions along with extensive leptomeningeal and dural deposits. Central nervous system involvement in both patients occurred within a time span ranging from 12 to 14 months from the time of initial diagnosis.

Metastatic neuroblastoma presenting as refusal to use the left upper extremity in a six-year-old girl

“…Neuroblastoma, a malignant neoplasm arising from neural crest cells, is the most common extracranial tumor in children [1][2][3]. Unfortunately, over 50% of patients have metastatic disease to the bone and marrow at the time of presentation.…”

“…Unfortunately, over 50% of patients have metastatic disease to the bone and marrow at the time of presentation. Despite this high rate of metastases, intracranial metastases are seen only rarely with initial presentation of neuroblastoma, with a reported incidence of approximately 0.6 percent [1]. Interestingly, the incidence of CNS involvement with recurrence of neuroblastoma is much higher, reported as being between 4-16% [1][2][3][4].…”

“…Being a rapidly spreading malignancy, neuroblastoma most often causes symptoms as a result of mass effect on or invasion of the other tissues of the body. The most common sites of metastases are bone marrow, bone cortex, lymph nodes, liver, and subcutaneous tissues [1]. Central nervous system involvement with neuroblastoma is much less common, and is most frequently seen with seeding of either the bloodstream or the cerebrospinal fluid [1].…”

“…The most common sites of metastases are bone marrow, bone cortex, lymph nodes, liver, and subcutaneous tissues [1]. Central nervous system involvement with neuroblastoma is much less common, and is most frequently seen with seeding of either the bloodstream or the cerebrospinal fluid [1]. Neurologic symptoms from neuroblastoma have been reported multiple times in the literature, however nearly all of these cases are from involvement of the spinal cord.…”

“…Neuroblastoma is the most common extracranial neoplasm in children, commonly presenting at an advanced stage. Despite the high prevalence of metastatic disease with neuroblastoma, metastases to the central nervous system (CNS) are rare and predominantly involve the spinal cord [1]. We present a case of neuroblastoma with metastases to the brain presenting as refusal to move the left upper extremity that initially appeared to be both a subdural hematoma and epidural hematoma on computed tomography (CT) of the head.…”