Figure 1: Ultrasound of the left labia majora demonstrating a well-defined, heterogeneous, predominantly hypoechoic solid mass. This sonographic appearance confirmed the lesion’s solid nature of the swelling, prompting subsequent tissue biopsy for definitive diagnosis.

Figure 2: Abdominal ultrasound demonstrating the primary suprarenal mass and hepatic metastases. (A) Large, heterogeneous, predominantly solid mass arising from the left suprarenal region, consistent with the primary adrenal neuroblastoma. (B) Transverse ultrasound view of the liver illustrating gross hepatomegaly with numerous multifocal, hypoechoic nodules, characteristic of hepatic metastases at presentation.

Figure 3: Comparative contrast-enhanced Computed Tomography (CT) images of the left labial metastasis. (A) Pre-treatment axial CT image demonstrating the well-defined, soft tissue density mass (arrow) within the subcutaneous tissue of the left labia majora. (B) Axial CT image of the same region obtained three months after initiation of chemotherapy, demonstrates a measurable reduction in size of the left adrenal mass (arrow), consistent with the partial systemic treatment response.

Figure 4: Comparative contrast-enhanced Computed Tomography (CT) images of the hepatic metastases. (A) Pre-treatment axial CT image of the upper abdomen illustrating significant hepatomegaly with multiple large, heterogeneous, enhancing hypodense masses, consistent with widespread metastatic neuroblastoma. (B) Axial CT image of the liver three months after commencing chemotherapy, showing a general decrease in the size and attenuation of the previously identified metastatic lesions, indicating a favorable partial systemic response to treatment.