An Unfavorable Metastatic Site at Initial Diagnosis in a 2-year-old Boy with Neuroblastoma

Neuroblastoma (NB) is considered one of the malignant tumors of the nervous system which originates from primordial neural crest cell and is known as the most common extra-cranial solid tumor in childhood. This tumor which is often intra-abdominal, metastases in various sites including the skull, long bones, liver, bone marrow and lymph nodes, but lung metastasis at initial diagnosis is rare (0.2-3.7%). Here, the authors reported a two-year-old boy who referred to Imam Hussein Children's Hospital affiliated to Isfahan University of Medical Sciences, Iran in April 2017 with complaint of abdominal pain and distension along with diarrhea, vomiting and fever. In physical examination, a palpable mass was observed at the right side of the abdomen, that in further studies, NB with lung metastasis along with poorly differentiated, low MKI, positive MYCN amplification was reported. This is the first documented case report of NB with lung metastasis from Iran. In conclusion, although lung is considered as an unfavorable metastatic site for NB, in high grade and poor prognosis cases, this organ should also be examined in metastatic site examinations. Therefore, lung High-resolution computed tomography (HRCT) is introduced as the gold standard modality for this work.