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August 1979

Occult Neuroblastoma: Difficulties of Diagnosis

Am J Dis Child. 1979;133(8):858-860. doi:10.1001/archpedi.1979.02130080098023

The hazards of differentiating neuroblastoma from leukemia have been commented on frequently in the literature of pediatrics. The following case presents not only another misdiagnosis of neuroblastoma, but also (1) a bone-marrow picture typical of leukemia, (2) an apparent clinical and bone-marrow response to antileukemia therapy, and (3) a reexamination of the diagnostic dilemmas involved.

Report of a Case.—A 2½-year-old boy was referred to North Carolina Memorial Hospital, Chapel Hill, on June 12, 1977, for assessment of fatigue, bruisability, and pallor. Results of physical examination showed hepatosplenomegaly and diffuse petechiae and ecchymoses.

Results of tests had the following values: hemoglobin, 9.2 g/dL; hematocrit, 30%; WBCs, 21,800/cu mm, with 1% blast forms, 1% myelocytes, 4% metamyelocytes, 20% band forms, 23% polymorphonuclear leukocytes, 43% lymphocytes, 3% atypical lymphocytes, and 5% monocytes; four nucleated RBCs/100 WBCs; and platelets, 16,500/cu mm. Abnormal blood chemistry levels were SGOT, 483 Svedberg flotation units; lactose dehydrogenase,

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