The poor outcome in the present patient was attributed to several factors: the tumor’s involvement with major blood vessels and nerves, which made surgical removal challenging; the presence of undifferentiated neuroblastoma within the heterogeneous tumor; and the residual high-grade neuroblastoma with an ALK mutation (R1275Q) that was refractory to chemotherapy and led to multiple metastases. The gene discussed is ALK; the disease is neuroblastoma.