Ann Lab Med.  2013 Mar;33(2):89-96. 10.3343/alm.2013.33.2.89.

Presence of Differentiating Neuroblasts in Bone Marrow is a Favorable Prognostic Factor for Bone Marrow Metastatic Neuroblastoma at Diagnosis

• Park SH
• Kim S
• Park CJ
• Jang S
• Chi HS
• Koh KN
• Im HJ
• Seo JJ

• KMID: 1781306
• DOI: http://doi.org/10.3343/alm.2013.33.2.89

Abstract

BACKGROUND
The prognostic impact of the presence of differentiating neuroblasts in bone marrow (BM) remains unclear in BM metastatic neuroblastoma (NB). We aimed to identify the prognostic impact of differentiating neuroblasts in BM at diagnosis and after chemotherapy.
METHODS
A total of 51 patients diagnosed with BM metastatic NB at Asan Medical Center between January 1990 and July 2005 were enrolled. BM histology and laboratory data along with overall survival (OS) were compared with regard to the differentiation status of neuroblasts in BM at diagnosis and after chemotherapy.
RESULTS
Among the 51 patients, 13 (25.5%) exhibited differentiating neuroblasts in BM at diagnosis and 17/51 (33.3%) exhibited them after chemotherapy. The only significant difference among patient groups was the improved OS in patients with differentiated neuroblasts in BM at diagnosis (P=0.021). In contrast, the differentiation status of neuroblasts in BM after chemotherapy did not affect OS (P=0.852).
CONCLUSIONS
Our study is the first report describing the presence of differentiating neuroblasts in BM. The presence of differentiating neuroblasts in BM at diagnosis may be a favorable prognostic factor for patients with BM metastatic NB; however, the same phenomenon after chemotherapy is irrelevant to prognosis.

Keyword

Differentiating neuroblasts; Neuroblastoma; Bone marrow; Metastasis; Prognosis

MeSH Terms

Adolescent
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Bone Marrow/*pathology
Bone Marrow Cells/*cytology
Bone Marrow Neoplasms/*diagnosis/secondary
Cell Differentiation
Child
Child, Preschool
Female
Humans
Infant
Karyotyping
Male
Neoplasm Grading
Neuroblastoma/*diagnosis/drug therapy/pathology
Prognosis
Survival Analysis
Young Adult

Figure

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  Fig. 1 Undifferentiated neuroblasts in bone marrow aspirate (A, Wright stain, ×400) and a clot section (B, H&E stain, ×400) at diagnosis. The tumor consisted of immature neuroblasts with dispersed nuclear chromatin and scanty cytoplasm embedded in a fibrillar matrix. Some mitotic cells were detected. Differentiating neuroblasts in a bone marrow clot section (C, H&E stain, ×400) and immunohistochemical stain with CD56 (D, CD56 immunohistochemical stain, ×400). Synchronous differentiation of the nucleus (an enlarged, eccentric nucleus with a vesicular chromatin pattern and usually a single prominent nucleolus) and conspicuous, eosinophilic or amphophilic cytoplasm suggests differentiating neuroblasts (indicated by an arrow).

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  Fig. 2 Overall survival of patients with bone marrow metastatic neuroblastoma according to differentiation status of neuroblasts in bone marrow at diagnosis.Abbreviation: Diff, differentiation.

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  Fig. 3 Overall survival of patients with bone marrow metastatic neuroblastoma according to the differentiation status of neuroblasts in bone marrow after chemotherapy (A, patients who exhibited differentiating neuroblasts in bone marrow after chemotherapy; B, patients who did not exhibit differentiating neuroblasts in bone marrow after chemotherapy; C, patients who did not exhibit bone marrow metastasis after chemotherapy).Abbreviation: Diff, differentiation.

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