LAUSR

A 10-day-old female neonate presented with lower abdominal mass and weakness in the both lower limbs. Clinically, flanks were full with palpable lump in the left side. There was flaccid paralysis in both lower limbs with bladder and bowel incontinence. Ultrasonography (USG) of the whole abdomen showed bilateral hypoechoic mass in the psoas region. Contrast enhanced computed tomography (CECT) of the abdomen showed a lobulated, enhancing mass of 41 × 30 × 26 mm in the upper pole of left kidney with patchy calcification in the left psoas region and the specks of calcifications extended to the spinal canal at D 10 to L 1 level. The features were suggestive of congenital neuroblastoma (NB) with intraspinal extension (Fig. 1). Blood hemogram and urea creatinine were normal, but 24-h urinary vanillylmandelic acid (VMA) level was raised (118.3 mg/g creatinine). USG-guided fine needle aspiration cytology (FNAC) of the mass revealed small round cell tumor with scanty cytoplasm. After discussion with neurosurgeon and oncologist, four cycles of neoadjuvant chemotherapy (NAC) were administered. The baby tolerated chemotherapy well and tumor mass was gradually reduced. After four cycles of chemotherapy, the mass was completely abolished while neurological symptoms were not. We referred the neonate to neurosurgery department for further opinion and possible surgical intervention. Unfortunately, the baby did not return back for further treatment.