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Table 1. Prognostic Evaluation of Neuroblastic Tumors According to the International Neuroblastoma Pathology Classification (Shimada System)a

International Neuroblastoma Pathology classification Original Shimada classification Prognostic group 
Neuroblastoma(Schwannian stroma-poor)bStroma-poor
<1.5 yrsPoorly differentiated or differentiating & low or intermediate MKI tumor
1.5–5 yrsDifferentiating & low MKI tumor
<1.5 yrsa) undifferentiated tumorc
b) high MKI tumor
1.5–5 yrsa) undifferentiated or poorly differentiated tumor
b) intermediate or high MKI tumor
≥5 yrsAll tumors
Ganglioneuroblastoma, intermixed(Schwannian stroma-rich)Stroma-rich Intermixed (favorable)Favorabled
Ganglioneuroma(Schwannian stroma-dominant)
MaturingWell differentiated (favorable)Favorabled
Ganglioneuroblastoma, nodular(composite Schwannian stroma-rich/stroma-dominate and stroma-poor)Stroma-rich nodular (unfavorable)Unfavorabled

MKI: mitosis-karyorrhexis index.
aReprinted with permission. Copyright © 1999 American Cancer Society. All rights reserved.[2] Hiroyuki Shimada, Inge M. Ambros, Louis P. Dehner, Jun-ichi Hata, Vijay V. Joshi, Borghild Roald, Daniel O. Stram, Robert B. Gerbing, John N. Lukens, Katherine K. Matthay, Robert P. Castleberry, The International Neuroblastoma Pathology Classification (the Shimada System), Cancer, volume 86, issue 2, pages 364–72.
bSubtypes of neuroblastoma were described in detail elsewhere.[6]
cRare subtype, especially diagnosed in this age group. Further investigation and analysis required.
dPrognostic grouping for these tumor categories is not related to patient age.


  1. Shimada H, Ambros IM, Dehner LP, et al.: The International Neuroblastoma Pathology Classification (the Shimada system). Cancer 86 (2): 364-72, 1999.  [PUBMED Abstract]

  2. Shimada H, Ambros IM, Dehner LP, et al.: Terminology and morphologic criteria of neuroblastic tumors: recommendations by the International Neuroblastoma Pathology Committee. Cancer 86 (2): 349-63, 1999.  [PUBMED Abstract]