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February 11, 1974

Widened Cranial Sutures in Metastatic Neuroblastoma

Author Affiliations

Nassau County Medical Center East Meadow, Long Island, NY
St. John's Hospital Smithtown, Long Island, NY

JAMA. 1974;227(6):659. doi:10.1001/jama.1974.03230190051023

To the Editor.—  Enlargement of the head and widening of the cranial sutures are fairly common complications of metastatic neuroblastoma. The cause is not clearly understood. We recently observed these signs in a child with a rapidly progressive tumor.

Report of a Case.—  An 18-month-old girl with persistent fever and vomiting developed an ear infection, treated with antibiotics. Examination three and a half weeks later showed ecchymosis of the left upper eyelid, and a large mass in the left side of the abdomen extending to the iliac crest. The hemoglobin level was 6.5 gm/100 ml; hematocrit reading, 22%. A bone marrow aspiration showed tumor cells. Serum alkaline phosphatase, lactic dehydrogenase, and serum glutamic oxaloacetic transaminase levels were all markedly elevated. A large mass (shown by intravenous pyelogram) displaced the left kidney laterally and inferiorly. Osteolytic lesions appeared in both lower femurs, and skull roentgenogram showed slight separation of the cranial