Massive hepatomegaly in a neonate: an unusual cause

A female neonate presented with progressive abdominal distension. Liver was palpable, 11 cm below costal margin and a spleen of 10 cm. USG abdomen revealed massive hepatomegaly with multiple nodules in liver, kidney size and texture being normal. Contrast enhanced CT scan of the abdomen was suggestive of enlarged multinodular liver with splenomegaly. Liver biopsy revealed replacement of liver architecture by small rounded cells, which were positive for synaptophysin and S100 stains suggestive of neuroblastoma. A repeat abdominal radiological evaluation revealed a small 2 x 1 cm mass in left suprarenal area. Neuroblastoma stage 4S presenting as hepatomegaly is rare.