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Gross appearance: Adrenal primary tumor from a patient with stage 4S disease. Adrenalectomy performed by laparotomy procedure after mild chemotherapy. The tumor shows an extensive regression with only 10% of viable neuroblastic cells.

Gross appearance: Adrenal primary tumor from a patient with stage 4S disease. Adrenalectomy was performed by laparoscopic procedure. Tumor shows spontaneous regression with disappearance of 90% of the neuroblastic cells without any chemotherapy/irradiation therapy.

Stage 4S (S=special) patient with massive hepatomegaly causing respiratory/circulatory difficulty. During the clinical course of this case, tumor tissues in both primary (adrenal gland) and metastatic sites (liver and bone marrow) showed complete regression

Typical histology, neuroblastoma (stroma-poor), poorly differentiated subtype with a low MKI, of the liver involvement in stage 4S disease.

High power view of the typical histology of the liver involvement in stage 4S disease: Neuroblastoma (stroma-poor), poorly differentiated subtype with a low MKI. Some atrophic bile ducts are observed among tumor cells.

Regression (dropping-off of neuroblastic cells) of the liver lesion in stage 4S disease.

Less Common Features - Stage 4S

Stage 4S applies when the child is younger than 12 months of age and the cancer has spread to the skin, liver or bone marrow, but not to bone.


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