1. Neuroblastoma 936-8

2. Case Records Of the Massachusetts General Hospital Case 27-1995 New England Journal of Medicine 1995;333:579-586

3. Figure 1. Saggital ultrasound image of the left upper quadrant of the abdomen, showing a heterogenous left adrenal mass.

4. Figure 2. Contrast-enhanced abdominal CT scan showing a 3.5 cm, heterogenous left adrenal mass.

5. Figure 3. Sectioned surface of the left adrenal gland showing the tumor surrounded by a thin yellow rim of residual adrenocortical tissue.

6. Figure 4. Nodular tumor and rim of the adrenal gland (hematoxylin and eosin, x4)

7. Figure 5. Lymphoid tissue within tumor nodules (hematoxylin and eosin, x48).

8. Figure 6. Round neuroblasts with a delicate fibrillary background (hematoxylin and eosin, x90).

9. Figure 7. Ganglion cells mixed with lymphocytes (hematoxylin and eosin, x90).

10. Paraneoplastic (Neuroblastoma) Opsocolonus Opsoclonus herald sign 2-3% Mean age at onset 16 years Youngest 4 months of age Older than 2 years in only 13% Mediastinal tumor in 49-61% Tumor found within 3 months in 60%

11. Rarely associated with elevated catecholamines (VMA, HVA metabolites) Anti-neurofilament protein antibodies (M V 210 K) ± in sera Paraneoplastic (Neuroblastoma) Opsocolonus

12. Survival rate 90% two-year c.f. 30-34% other neuroblastoma cases Tumor removal may decrease, have no effect or exacerbate opsoclonus Spontaneous resolution may take months or years Paraneoplastic (Neuroblastoma) Opsocolonus

13. http://www.library.med.utah.edu/NOVEL