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A full term female infant, born following a pregnancy complicated by maternal hypertension and decreased fetal movements, presented within four hours of birth with respiratory distress, hepatomegaly, and disseminated intravascular coagulopathy. Abdominal magnetic resonance imaging (MRI) scan revealed a large heterogeneous mass (arrow in fig 1) located in the right adrenal gland compressing the kidney and multiple discrete hepatic lesions, suggestive of congenital neuroblastoma. Her condition deteriorated rapidly and she died on day 4 of life from multiorgan failure.
Postmortem examination confirmed the diagnosis of disseminated neuroblastoma. Nests of characteristic neuroblastoma cells are shown in the adrenal section and in the skull bone (insert, fig 2). Tumour deposits were also identified in the liver, pancreas, and perigastric lymph nodes. The maternal hypertension, fetal compromise, and rapid postnatal presentation suggest extensive in utero tumour growth and dissemination.