Shimada classification of neuroblastomas

Introduction

Term definitions:

• well differentiated: few randomly distributed aggregates of immature neuroblasts that don't form a mass
• intermixed: mature ganglion cells, neuritic processes with mature Schwann cells, mature fibrous tissue, few foci of neuroblastoma
• nodular: grossly evident nodule, microscopically neuroblastoma
• poorly differentiated: differentiated neuroblasts seen, < 5% of tumor cells

Classification

prognosis

• stoma rich - well differentiated intermixed: favorable
• stroma rich - nodular: unfavorable
• stroma poor: favorable
  • age < 18 months, mitotic-karyorrhexis index (MKI) < 200/5000
  • age 18-60 months, MKI < 100/5000 and differentiating
• stroma poor: unfavorable
  • age < 18 months, mitotic-karyorrhexis index > 200/5000
  • age 18-60 months, MKI > 100/5000 or undifferentiated