What are the symptoms of neuroblastoma?

Symptoms of Neuroblastoma

Neuroblastoma commonly presents with an abdominal mass or abdominal distension, but symptoms vary widely depending on tumor location and can include loss of appetite, weight loss, irritability, constipation, fever, hypertension, anemia, paralysis, bruising or swelling around the eyes, bone pain, and pancytopenia. 1

Primary Symptoms by Frequency

• Abdominal symptoms:

  • Abdominal mass (most common presentation)
  • Abdominal distension
  • Constipation

• Constitutional symptoms:

  • Loss of appetite
  • Weight loss
  • Fever
  • Irritability

• Hematologic manifestations:

  • Anemia
  • Pancytopenia
  • Bruising

• Neurological symptoms:

  • Paralysis
  • Bone pain
  • Swelling around the eyes

• Cardiovascular symptoms:

  • Hypertension (due to catecholamine secretion)

Location-Specific Symptoms

Neuroblastoma arises from primitive sympathetic nervous system cells and can occur anywhere sympathetic tissue exists 2, leading to location-specific symptoms:

1. Abdominal/Adrenal tumors (most common):

   • Abdominal mass
   • Distension
   • Constipation
   • Hypertension (if catecholamine-secreting)

2. Thoracic/Posterior mediastinal tumors:

   • Respiratory distress
   • Chest pain
   • Horner syndrome (ptosis, miosis, anhidrosis)

3. Paraspinal tumors:

   • Spinal cord compression
   • Neurological deficits
   • Radicular pain
   • Paralysis

4. Cervical tumors:

   • Neck mass
   • Horner syndrome

5. Pelvic tumors:

   • Urinary retention
   • Constipation
   • Lower extremity weakness

Metastatic Disease Presentations

Neuroblastoma commonly metastasizes, causing additional symptoms 3:

• Bone metastases:

  • Bone pain (may cause limping or refusal to walk in young children)
  • Skull prominence or lumps 4
  • Pathological fractures

• Bone marrow involvement:

  • Pancytopenia
  • Pallor
  • Fatigue
  • Recurrent infections
  • Easy bruising

• Orbital metastases:

  • Periorbital ecchymosis ("raccoon eyes")
  • Proptosis
  • Periorbital edema

Paraneoplastic Syndromes

Neuroblastoma can present with paraneoplastic syndromes 1, 5:

• Opsoclonus-myoclonus-ataxia syndrome (OMAS):

  • Rapid, irregular eye movements (opsoclonus)
  • Myoclonic jerks
  • Ataxia
  • Irritability
  • Sleep disturbance
  • Irregular muscle movements

• Vasoactive intestinal peptide (VIP) secretion:

  • Chronic watery diarrhea
  • Hypokalemia
  • Dehydration

Age Considerations

• Infants: May present with hepatomegaly, skin nodules, or respiratory distress
• Children <2 years: Often have localized disease with better prognosis
• Children >2 years: More likely to present with metastatic disease and constitutional symptoms
• Adults: Extremely rare but can present with abdominal discomfort and retroperitoneal masses 6

Clinical Pitfalls and Diagnostic Challenges

1. Misdiagnosis as orthopedic problems: Children with bone metastases may present with limping or refusal to walk, leading to delayed diagnosis 4

2. Varied presentations: The diverse symptomatology can delay diagnosis as symptoms may mimic more common childhood illnesses

3. Age-related differences: Symptoms and disease behavior vary significantly by age, with infants often having more favorable outcomes despite metastatic disease

4. Paraneoplastic syndromes: May be the only presenting symptom, with the primary tumor being small and difficult to detect

Early recognition of these symptoms is critical as prognosis is heavily dependent on age at diagnosis and disease stage, with better outcomes in younger patients with localized disease 3.

Healthcare providers should maintain a high index of suspicion for neuroblastoma in children presenting with persistent unexplained symptoms, particularly when multiple systems are involved.

AI-generated medical advice, not a substitute for professional medical care.