====== Neuroblastoma clinical features ======


   - **Symptoms**: Symptoms may vary depending on the location of the tumor, but common signs in children can include:
     - Abdominal pain or swelling (if the tumor is in the abdomen)
     - A palpable mass or lump
     - Bone pain or limping (if the cancer has spread to bones)
     - Unexplained weight loss
     - Irritability or lethargy
     - High blood pressure (if the tumor is producing catecholamines)
     - In some cases, **proptosis** (bulging eyes) or **blueberry muffin-like rash** (in cases of widespread metastasis)

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May present with abdominal mass, local or radicular pain, or (with high thoracic or cervical tumors) [[Horner’s syndrome]] Non-pulsatile [[exophthalmos]]. Spinal cord compression may occur from invasion through the neural foramen, and [[scoliosis]] may occur. Catecholamine precursors ([[homovanillic acid]] (HVA), [[vanillylmandelic acid]] (VMA) and [[dopamine]]) may be excreted and cause HTN (can be assayed in urine). Periorbital tumor metastases may produce raccoon’s eyes (usually unilateral [[ecchymosis]] and [[proptosis]]). Many of the low-grade tumors regress spontaneously and never present.

Opsoclonus-myoclonus syndrome: in peds, usually indicates neuroblastoma.

The most common clinical presentation of abdominal NBL in children is a large flank mass; however, other rare presentations may include pelvic NBL, bilateral, pelviabdominal, and neonatal NBL, other manifestations may associate with the tumor mass-like metastatic lesions in bone or liver, pallor, abdominal pain, weight loss, and fever. NBL is a biologically active tumor secreting vanillylmandelic acid (VMA) and homovanillic acid, or other metabolites such as catecholamines, neuron-specific enolase (NSE), and vasoactive intestinal peptides in some cases
((Park JR, Eggert A, Caron H. Neuroblastoma: Biology, prognosis, and treatment. Hematol Oncol Clin North Am 2010;24:65-86.)).

Horner’s syndrome 2nd order neuron (preganglionic)

Etiologies of dysfunction: lateral sympathectomies, significant chest trauma, apical pulmonary neoplasms (Pancoast tumor), high thoracic or cervical [[neuroblastoma]].