Neuroblastoma-remembering the three physicians who described it a century ago: James Homer Wright, William Pepper, and Robert Hutchison.

Neuroblastoma is often widespread at the time of diagnosis. Three physicians between 1900 and 1910 played an important role in the pathologic definition of neuroblastoma and its route of spread in relation to the age of the patient. These findings eventually led to the advances in treatment and decreased morbidity of today. In 1910 James Homer Wright was the first to recognize the tumor as being of primitive neural cell origin, calling it neuroblastoma and emphasizing the bundle of cells termed rosettes. While Wright recognized the neural nature of the tumor, the authors of previous reports had described its two distinct patterns of spread. In 1901 William Pepper published a series of infants with massive hepatic infiltration associated with adrenal tumors without spread to bone, and in 1907 Robert Grieve Hutchison reported his experience with a similar pathologic process in older infants and children who had orbital and skull metastases. Wright's valuable unifying concept served to tie together the descriptions of Pepper and Hutchison. A century later the names of these physicians should be remembered-Wright, who defined the adrenal tumor as of primitive neural origin, Pepper for his clinically accurate report of massive liver involvement in the infant, and Hutchison for describing the propensity of the tumor to spread to bone in older children.