International Journal of Medicine Research

Authors
Mounir Kisra, Driss Hanine, Zakaria Aboulam, Jaouad Bouljrouf

Abstract
Neuroblastoma is the most common extracranial solid tumor in children under 5 year of age. Adrenal bilateral involvement is rare and characterized by an extraordinary clinical heterogeneity, ranging from spontaneous regression to metastatic progression resistant to all treatment. Prognostic factors that explain this variability is dominated by age, stage, and a set of biological characteristics that which allow the grouping of neuroblastoma into groups of risk, which affect different therapeutic strategies in which surgery retains an important place. This work provides a particular perspective of the role of surgery in the management of bilateral neuroblastoma and examines the interest of conservative surgery in this particular localization. In this study, we report 8 cases of bilateral adrenal neuroblastoma treated between 2001 and 2014, the median age at diagnosis is 9 and a half months with a male predominance, discovery circumstances are most often due to the presence of metastases. The therapeutic management consists of neoadjuvant chemotherapy followed by conservative surgery followed by postoperative chemotherapy. All operated patients received this regimen, with a low incidence of relapse and excellent survival. The combination of chemotherapy to surgery reduced the tumor volume thus allowing a satisfactory surgery with minimal risk and minimal postoperative morbidity. The low incidence of relapse and the risk of adrenal failure if radical surgery is performed, argue against an aggressive surgical approach. In the future, it will be necessary to study the biological profile of these bilateral tumors, to characterize the differences between the unilateral neuroblastoma, if they exist, and understand the physiopathology of this bilateral involvement.