Abstract
A 38-month-old boy presented with several weeks history of weight loss, irritability, poor appetite, and low-grade fever. Physical examination revealed a firm abdominal mass and CAT scan a6.7 × 6.2 × 11 cm left suprarenal tumor. Biopsy confirmed a neuroblastoma and staging demonstrated disseminated disease. Biological markers were uniformly unfavorable [elevated neuron-specific enolase (140 μg/L) and ferritin (349 μg/L), N-myc amplification, unfavorable history,1 and inverted VMA (vanillylmandelic acid)/HVA (homovanillic acid) urinary catecholamine ratio].