A **3-month-old female infant** presents with fever and abdominal distension. ### Imaging Findings **Ultrasound Abdomen** * Left suprarenal mass measuring **52 × 50 × 39 mm** * Fine speckled calcifications within the lesion * Left adrenal gland not separately visualized * Moderate hepatomegaly * Multiple hyperechoic hepatic nodules suggestive of metastatic deposits **PET-CT Findings** * FDG-avid left suprarenal primary mass * FDG-avid periportal, peripancreatic, and locoregional lymph nodes * Multiple FDG-avid hepatic lesions * No skeletal metastasis identified Questions 1. What is the most likely diagnosis? 2. What are the common differential diagnoses of a suprarenal mass in infancy? 3. What is the significance of calcification within an adrenal mass in a 3-month-old infant? 4. Based on the imaging findings, what stage would you assign to this tumor? 5. Which biochemical markers should be ordered to confirm the diagnosis? 6. What genetic abnormality is associated with poor prognosis in this condition? 7. Why can some infants with metastatic disease still have a favorable outcome? 8. What is the standard treatment approach for this patient? The infant has: * Liver metastases * No bone metastases * Age < 18 months *Which special neuroblastoma stage is characterized by this pattern, and why does it have a unique prognosis compared with other metastatic stages?* Discuss your diagnosis, staging, investigations, and management plan.
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