A Boy with Neuroblastoma Presented Initially with Chronic Secretory Diarrhea and Hypokalemia
Keywords:
Neuroblastoma, Chronic secretory diarrhea, HypokalemiaAbstract
Abstract: A 4 year-old boy presented with a 3-year history of chronic watery dianhea, failure to thrive and periodic weakness. The initial investigation revealed low serum potassium level. The stool electrolytes showed high sodium and chloride contents and the diarhea continued after being fasted, all of which led to a diagnosis of secretory diarrhea and a search for neurosecretory tumor. The urine vanillylmandelic acid (VMA)/creatinine (Cr) ratio was high. The abdominal C'T disclosed a right suprarenal mass. Clumps of large primitive cells in rosette formation were found in the bone marrow aspiration smear. The patient underwent a laparotomy in which the suprarenal tumor was removed. The diarheal symptom disappeared after the operation. The pathologic study confirmed that the excised tumor was a ganglioneuroblastoma. This is an illustrative case of neuroblastoma with the uncommon paraneoplastic syndrome as a presenting symptom.
Downloads
References
Brodeur GM, Marris JM. Neuroblastoma. In: Pizzo PA, Poplack DG, eds. Principles and practice of pediatric oncology. 4" ed. Philadelphia: Lippincott Williams & Wilkins 2002:895-937.
Ghishan FK. Chronic diarrhea. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson textbook of pediatrics. 17h ed. Philadelphia: W.B. Saunders Company 2004:1276-81.
Tang KT, Lee HC, Liang DC, Chen SH, Liu HC, Sheu JC. Neural-crest tumor presenting with chronic diarhea: a report of three cases. J Formos Med Assoc 2002:101:864-7.
Al-Mulhim I. Neuroblastoma in children: a 10-year experience in Saudi Arabia. J Trop Pediatr 1998,44:77-80.
Bourgois B, Boman F, Nelken B, Bonnevalle M, Turck D. Intractable diarhoea revealing a neuroblastoma hypersecreting the vasoactive intestinal peptide. Arch Pediatr 2004;11:340-3.
Wildhaber B, Niggli F, Bergstrasser E, Stallmach T, Sacher P. Paraneoplastic syndromes in ganglioneuroblastoma: contrasting symptoms of constipation and diarrhoea. Eur J Pediatr 2003;162:511-3.
Lofthouse CM, Akobeng AK, Adamski J, Brennan B. A 2-year-old boy with diarrhoea and failure to thrive. Lancet 2003;361:1012.
Rodriguez MM, Regalado JJ, Zaleski CG, Thomas C, Tamer AM. Chronic watery diarhea in a 22-month-old girl. J Pediatr 2000;136:262-5.
Joseph VT, Raj JP. Experiences in the treatment of neuroblastoma. Ann Acad Med Singapore 1988;17:145-51.
Carlsen NL, Schroeder H, Christensen IJ, et al. Signs, symptoms, metastatic spread and metabolic behavior of neuroblastomas treated in Denmark during the period 1943-1980 Anticancer Res 1987;7:465-73.
El Shafie M, Samuel D, Klippel CH, Robinson MG, Cullen BJ. Intractable diarrhea in children with VIP-secreting ganglioneuroblastomas. J Pediatr Surg 1983;18:34-6.
Scheibel E, Rechnitzer C, Fahrenkrug J, Hertz H. Vasoactive intestinal polypeptide (VIP) in children with neural crest tumours. Acta Paediatr Scand 1982;71.721-5.
Hansen LP, Lund HT, Fahrenkrug J, Sogaard H. Vasocative intestinal polypeptide (VIP)-producing ganglioneuroma in a child with chronic diarhea. Acta Paediatr Scand 1980;69:419-24.
Williams TH, House RF, Jr., Burgert EO, Jr., Lynn HB. Unusual manifestations of neuroblastoma: chronic diarrhea, polymyoclonia-opsoclonus, and erythrocyte abnormalities. Cancer 1972:29:475-80.
Kaplan SJ, Holbrook CT, McDaniel HG, Buntain WL, Crist WM. Vasoactive intestinal peptide secretingtumors of childhood. Am J Dis Child 1980;134:21-4.
Qualman SJ, O'Dorisio MS, Fleshman DJ, Shimada H, O'Dorisio TM. Neuroblastoma. Correlation of neuropeptide expression in tumor tissue with other prognostic factors. Cancer 1992,70:2005-12.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
