Neuroblastoma in the Elderly and SIADH: Case Report and Review of the Literature

Abstract

Objective. To report the rare case of a thymic neuroblastoma, in an elderly woman with SIADH at presentation. Methods. Clinical and biochemical data of the patient are presented and the pertinent literature is reviewed. Results. a 79-year-old woman was admitted into our department with worsening asthenia, severe hyponatremia (114.8 mEq/L), low plasma osmolarity (253 mEq/L), and inappropriate urinary sodium concentration (151 mEq/L). CT scan showed an a large solid inhomogeneous mass in the anterior mediastinum. 18F-FDG-PET/CT showed uptake in the mass. On continuous 3% hypertonic saline infusion, sodium gradually increased without achieving normal values. The patient underwent surgery, followed by full normalization of sodium levels. Tumor cells were positive for neuroendocrine markers. Thymic neuroblastoma with SIADH was diagnosed. Conclusions. Neuroblastoma is an extremely rare tumor in the elderly. Contrary to children and younger adults, neuroblastoma in older adults is typically localized in the anterior mediastinum and is often associated with SIADH. Moreover, it has mainly local aggressiveness in this age group, without metastatic spread; thus radical surgery achieves cure in most cases.

The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes

“…The exceedingly rare neuroblastomas and ganglioneuroblastomas of the thymic region are unusual, since they occur in elderly patients. 86, 87 It is unknown, whether they are genetically distinct from their childhood counterparts.…”

Neuroblastoma after Childhood: Prognostic Relevance of Segmental Chromosome Aberrations, ATRX Protein Status, and Immune Cell Infiltration

“…Neuroblastoma (NB), a common solid tumor in childhood, is infrequent in patients over 10 years of age. Adolescent and young adult (AYA) NBs are usually included as older patients, whereas NB in middle-aged and elderly adults is often ignored in these studies [1] , [2] , [3] , [4] , [5] . Several studies have demonstrated that tumors of older NB patients present a worse prognosis than their childhood NB counterparts, despite the presence of very few unfavorable biologic markers [3] , [6] , [7] , [8] .…”

Head neck neuroblastoma in early childhood: a rare case report

“…12 Literature review showed many primary site neuroblastomas spreading to others parts of the body, but none of these patients below 3 years of age presented with large cheek mass. 13 Neuroblastomas have a very broad spectrum of clinical behavior which ranges from spontaneous regression to maturation to a benign ganglioneuroma, or aggressive disease with metastasis leading to death.…”