What is the interpretation of a 1-year-old boy diagnosed with poorly differentiated and high MKI neuroblastoma?

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I am providing a review at the request of the family. He is a 1-year-old boy with stage four neuroblastoma. He had presented with fever, irritability and abdominal distension. Initial work up showed a right sided suprarenal mass on USS (ultrasound scan) which was confirmed on CT scan (computed tomography) of abdomen and pelvis which showed a large heterogeneous lesion of 10 cm in size with necrosis and calcification. Abdominal nodes were also noted. There was no other evidence of metastases. FDG PET (fluorodeoxyglucose-positron emission tomography) or CECT (contrast enhanced computed tomography) showed uptake in mass and nodes (maximum 8.88) without other areas of uptake. Bone marrow testing was negative for extrinsic cells. Biopsy of tumor also showed neuroblastoma MYCN-amplified gene. Urine catecholamines were elevated. LDH (lactic dehydrogenase) at diagnosis was 5600 and ferritin was 890. He was deemed to have stage L2 NB and staged as high risk.

He was commenced on chemotherapy as per COG (children oncology group) of rapid COJEC (Cisplatin, Vincristine, Carboplatin, Etoposide, and Cyclophosphomide) induction chemotherapy and was completed. Chemotherapy was well-tolerated without major adverse events.

End of induction CTCAP (computed tomography of chest, abdomen and pelvis) showed significant reduction of tumor size to maximum diameter of 3.8. He then underwent resection of tumor. Surgery was well tolerated. However, parents were told that resection of “80% of tumor” was performed. Over the last two days, he has become irritable, apparently with increased pain and low grade fever. A recent USS appeared to show increase in abdominal mass. A CT is planned for early next week.