No one wants to inform a family that their child has a malignancy, but our jobs certainly place us in a position where it is occasionally necessary for us to do so. While this may not be an aspect that we look forward to, by actively considering potential malignancies on our differential diagnosis lists we can benefit the patient by offering early detection and treatment. Unfortunately, many malignancies initially have subtle and various presentations that can be misconstrued as more benign illnesses initially. Neuroblastoma is a great example of this.
2nd most common malignant solid tumor in pediatric patients.
Malignancy arising from neural crest tissue.
The pattern of these neuroblasts’ migration correlates with the sites of primary neuroblastoma (ex, sympathetic ganglia, adrenal glands).
75% of primary sites are in the abdomen.
2/3 of abdominal tumors originate from the adrenal glands.
Early symptoms can be very nonspecific.
Diarrhea (4% of cases will have severe diarrhea from a tumor secreting vasoactive intestinal peptides).
Later symptoms/findings often depend on tumor location.
May be asymptomatic (discovered during exam)
Often noted to be hard with irregular border, in contrast to the smooth edges found with renal tumors.
May lead to abdominal distension and/or constipation symptoms.
Focal neurologic deficit
Spinal cord compression (from extension between the neuronal foramina)
Weakness, limping, paralysis, or bladder/bowel dysfunction.
Lower limb paresis from epidural extension of paraspinal tumor occurs in 4% of cases.
Neurologic complaint plus Abdominal Mass/Discomfort should evoke consideration of neuroblastoma.
I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.