A newborn child is noted to have a bulky abdominal tumor. CT scans reveal that the mass involves the right abdomen and retroperitoneum. The tumor is resected, revealing ganglion cells and primitive, small, round cells occasionally organized in rosettes, embedded in a fibrillary pink matrix. Special studies confirm the likely diagnosis. Which of the following features of this tumor is associated with a poorer prognosis?

**Core Concept**
The question describes a case of neuroblastoma, a common extracranial solid tumor in children characterized by the presence of ganglion cells and primitive, small, round cells. Neuroblastoma often arises in the adrenal glands or along the sympathetic nervous system, and its diagnosis is confirmed by special studies such as immunohistochemistry and molecular analysis.

**Why the Correct Answer is Right**
The presence of **ganglion cells** and **rosettes** in the tumor is a hallmark of neuroblastoma. The prognosis of neuroblastoma is associated with several factors, including the **stage of the disease**, the **age of the patient**, and the **histopathological features** of the tumor. Specifically, neuroblastomas with **ganglion cells** tend to have a better prognosis than those without, as ganglion cells indicate a more mature tumor.

**Why Each Wrong Option is Incorrect**
* **Option A:** **Metastasis** is a feature of neuroblastoma that can affect prognosis, but it is not the specific feature associated with a poorer prognosis.
* **Option B:** **Age of the patient** is an important prognostic factor in neuroblastoma, with infants having a better prognosis than older children. However, the presence of ganglion cells is a more specific indicator of prognosis.
* **Option C:** **Histopathological features** such as the presence of rosettes and ganglion cells are important in diagnosing neuroblastoma, but they are not directly associated with a poorer prognosis.

**Clinical Pearl / High-Yield Fact**
Neuroblastomas with **ganglion cells** often have a better prognosis than those without, as they indicate a more mature tumor. This is an important clinical correlation to remember when evaluating pediatric tumors.

**Correct Answer:** C.

✓ Correct Answer: A. Amplification of N-myc gene