The neuroblastoma is a malignant neoplasm of sympathetic tissue origin and can arise in any site where such tissues exist. Its metastatic spread is threefold: direct regional extension along fascial planes; lymphatic extension to regional and distant lymph node echelons; and hematogenous dissemination to bone and soft tissue. Indeed, we have frequently observed all three modes of extension in an individual patient.
We have noted previously the ability of irradiation to control this disease.27 However, one must be mindful of the possibility of spontaneous regression of this neoplasm without specific therapy when one evaluates any mode of therapeutic regimen.28
Total surgical extirpation of the neuroblastoma is not always possible because of the tendency for early regional extension of this neoplasm. Local irradiation, therefore, plays a major role to eradicate disease.
Thus, in the cases of primary involvement of the adrenal medulla, one may find localized extension to involve