Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2021; 9(23): 6816-6823
Published online Aug 16, 2021. doi: 10.12998/wjcc.v9.i23.6816
Nasal metastases from neuroblastoma-a rare entity: Two case reports
Ying Zhang, Wen-Bin Guan, Rui-Fen Wang, Wen-Wei Yu, Rui-Qi Jiang, Yi Liu, Li-Feng Wang, Jia Wang
Ying Zhang, Wen-Bin Guan, Rui-Fen Wang, Wen-Wei Yu, Rui-Qi Jiang, Yi Liu, Li-Feng Wang, Jia Wang, Department of Pathology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
Author contributions: Zhang Y collected the data and drafted and revised the manuscript; Guan WB and Wang RF did the literature search; Yu WW, Jiang RQ and Liu Y conducted morphology, immunohistochemistry and fluorescence in situ hybridization analysis; Wang LF and Wang J contributed to the concept and design and approved the final version of the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report and any accompanying images.
Conflict-of-interest statement: Authors have nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia Wang, MD, Attending Doctor, Department of Pathology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. wangjia02@xinhuamed.com.cn
Received: January 26, 2021
Peer-review started: January 26, 2021
First decision: April 25, 2021
Revised: May 8, 2021
Accepted: June 22, 2021
Article in press: June 22, 2021
Published online: August 16, 2021
Processing time: 190 Days and 5.4 Hours
Abstract
BACKGROUND

Neuroblastoma (NB) is one of the most common malignancies in children. Metastasis in NB is not uncommon. However, nasal metastases are rare. Here, we reported two pediatric cases of nasal metastases.

CASE SUMMARY

Case 1 was a 3-year-old boy without a history of NB. Case 2 was a 10-year-old girl who had a history of NB for 6 years. Both of them presented with symptoms of nasal and sinus masses such as epistaxis or discharge from the nose. The radiologic imaging results revealed masses in the nasal cavity or nasopharynx in both cases and a mass in the right adrenal gland of case 1. The pathologic examination of biopsy samples of their nasal masses revealed “small round blue-cell tumor” along with abundant vascular fibrous septa. The tumor cells expressed synaptophysin, cluster of differentiation 56, chromogranin A, paired like homeobox protein 2B and a very high Ki67 index in both case but were negative for vimentin, desmin, leucocyte common antigen and cytokeratin. Myelocytomatosis viral related oncogene, neuroblastoma derived (MYCN) amplification was detected in both cases. Finally, the two cases were diagnosed as nasal metastases from NB based on the clinical and pathologic findings. The two patients affected by NB were > 18 mo old, the primary tumor location was adrenal gland, and they presented with multiple metastases.

CONCLUSION

It is difficult to differentiate between metastatic NB in the nose and olfactory neuroblastoma in the absence of a history of NB. Paired like homeobox protein 2B can play an important role in the diagnosis and differential diagnosis of this disease.

Keywords: Nasal metastases; Neuroblastoma; Olfactory neuroblastoma; Children; Pathology; Paired like homeobox protein 2B; Case report

Core Tip: Nasal metastases from neuroblastoma (NB) is a rare disease that can be misdiagnosed in case of initial presentation with a nasal mass without a history of NB. In this study, we reported two pediatric cases of nasal metastases including one case without a history of NB. It can be difficult to differentiate between metastatic NB in the nose and olfactory neuroblastoma in the absence of a history of NB. Paired like homeobox protein 2B is very helpful for accurate diagnosis.