Neuroblastoma

Neuroblastoma is a malignant proliferation of neural-crest cells that normally contribute to the sympathetic nervous system, including sympathetic ganglia and the adrenal medulla. It is therefore not primarily a brain tumour, even when the child develops neurological findings. The tumour may arise in the abdomen, adrenal region, chest, neck, or pelvis, following the distribution of sympathetic tissue. It is the most common solid tumour in infants. Many neuroblastomas produce catecholamines, so an abdominal mass may occur alongside sweating, pallor, tachycardia, irritability, or elevated blood pressure. The clinical picture depends on four variables: where the primary tumour is located, whether it is compressing nearby structures, whether it has spread, and whether it is producing hormones or triggering a paraneoplastic syndrome. An infant or young child with increasing abdominal girth, poor feeding, constipation, vomiting, unexplained irritability, or a firm abdominal mass needs focused assessment rather than reassurance that the symptoms are gastrointestinal. Bone involvement may cause persistent pain, limp, refusal to walk, pallor, or unusual fussiness. Periorbital bruising or proptosis can suggest orbital spread. Neurological findings can arise through several different mechanisms:...