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Gross appearance of neuroblastoma (Schwannian stroma-poor), differentiating subtype: Adrenal primary tumor, stage 1. Tumor is soft in consistency, and has a uniform, fleshy, grayish-tan appearance and vague to fairly marked nodularity with thin, whitish, partially formed fibrous bands outlining the nodules. The tumor in this subtype is usually less hemorrhagic than those in the poorly differentiated subtype.

Differentiating neuroblasts, defined as neuroblastic cells in a transitional stage of ganglionic maturation, shows synchronous differentiation of the nucleus (an enlarged, eccentrically located nucleus with a vesicular chromatin pattern and usually a single prominent nucleolus) and of the cytoplasm (a conspicuous, eosinophilic or amphophilic cystplasm with diameter >2x that of the nucleus). Differentiating neuroblasts usually produce multiple neurites.

Neuroblastoma (Schwannian stroma-poor), differentiating subtype. Tumor is composed of neuroblastic cells with more than 5% differentiating neuroblasts. Tumor cells are loosely distributed in a background of abundant neuropil.

Neuroblastoma (Schwannian stroma-poor), differentiating subtype. Many of the tumor cells have an appearance of differentiating neuroblast.

Neuroblastoma (Schwannian stroma-poor), differentiating subtype. Tumor with this histology is not qualified as ganglioneuroblastoma, since it lacks ganglioneuromatous appearance with Schwannian stromal development (see the sections of ganglioneuroblastoma, intermixed and ganglioneuroma).

Neuroblastoma (Schwannian stroma-poor), Differentiating subtype. Tumor is predominantly composed of differentiating neuroblasts distributed in a background of neuropil. Note: Neuropil does not make stroma, but is a collection of cytoplasmic processes (neurites) produced by the neuroblastic cells

Neuroblastoma (Schwannian stroma-poor), Differentiating subtype. High power view of the differentiating neuroblasts with both nuclear and cytoplasmic enlargement. Note: Presence of Nissl substances in the cytoplasm.

Differentiating


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