Abstract
A serial and simultaneous determination of urinary levels of VMA and HVA by means of thin-layer chromatography was carried out in ten cases of neuroblastoma, and significance of these assays was assessed in the follow-up of these patients. Other CA metabolites such as VLA and MHPG were qualitatively assayed at times by using paper chromatography of Armstrong et al.
The findings obtained are:
1) At the time of diagnosis, both levels of VMA and HVA were abnormally high in eight cases, only HVA was elevated in one case with the upper limit of VMA, and these two metabolites were within the normal ranges in one case.(TABLE I)
2) A rapid fall of markedly elevated VMA and HVA was observed following the complete removal and, even inoperable cases, good responses to chemotherapeutic agents.(Fig. 1)
3) No fall of HVA and VMA after operation indicated incomplete extirpation of the tumor and/or presence of massive metastases. It was also suggested that the surgical intervention might be a possible trigger for spread of metastases, because of the postoperative rapid rise of these compounds in urine.(Fig. 2)
4) A serial and simultaneous follow-up of VMA and HVA was of help for an early biochemical detection of any development of recurrent masses in a patient whose illness was silent.(Fig. 4)
5) The cases investigated were tentatively classified as follows (Scheme 1):
Group A (4 cases): Following the treatment, markedly elevated VMA and HVA returned to the normal level with the clinical improvement.(Fig. 1)
Group B (4 cases): Unresponsive to any treatment, VMA and HVA remained high or even became more elevated in association with clinical exacerbations.(Fig. 2)
Group C (1 case): Through his entire course, VMA was within the normal range. Significantly elevated preoperative HVA fell gradually to normal, during the period when he developed wide spread bone metastases.(Fig. 3)
Group D (1 case): At the onset, VMA and HVA were both normal and VLA only was elevated. Postoperatively, the rise of HVA was followed about a month later by a palpable recurrent mass. Eventually, HVA and VMA were markedly elevated at the terminal stage of his illness.(Fig. 4)
Group A revealed a favorable prognosis, even in the inoperable cases. All three cases under the age of one year were in this group. Patients in Group B were all above two year old and had a poor prognosis. Two cases in Group C and Group D were also expired.
