Neuroblastoma is the Most Likely Diagnosis
A child presenting with an abdominal mass and hypertension should be evaluated for neuroblastoma, as this combination represents a classic presentation of this malignancy. 1
Why Neuroblastoma is the Answer
Hypertension is a well-recognized clinical feature of neuroblastoma, occurring in approximately 25% of cases through catecholamine excess or renal artery compression. 1, 2
The combination of abdominal mass with hypertension is specifically characteristic of neuroblastoma, as patients commonly present with both findings together. 1
Neuroblastoma is the most common non-central nervous system tumor of childhood and frequently arises in the abdomen from the sympathetic nervous system. 3, 4
Hypertension in neuroblastoma is often severe and occurs particularly in young children under 2.5 years of age, affecting approximately 10% of all neuroblastoma cases. 5
Why Not the Other Options
Wilms Tumor (Not the Best Answer)
- While Wilms tumor should be considered in the differential diagnosis of a child with an abdominal mass, hypertension is less characteristic compared to neuroblastoma. 1
- Hypertension occurs in approximately 20% of Wilms tumor cases, but it is not as strongly associated with the clinical presentation as in neuroblastoma. 5
Hepatoblastoma (Incorrect)
- Hepatoblastoma typically presents with abdominal mass but hypertension is NOT a characteristic feature. 1
- Hepatoblastoma is characterized by elevated AFP levels and hepatic mass on ultrasound, not hypertension. 6
Beckwith-Wiedemann Syndrome (Not a Tumor Diagnosis)
- This is a syndrome that increases risk for tumors (Wilms tumor and hepatoblastoma), not a tumor diagnosis itself. 1
- The syndrome presents with distinctive features: macroglossia, omphalocele/umbilical hernia, and hemihyperplasia. 1
Essential Diagnostic Workup
Urinary catecholamines (VMA and HVA) are essential, as they are elevated in the majority of neuroblastoma patients. 1
Abdominal imaging with ultrasound initially, followed by CT or MRI to characterize the mass and assess for renal artery compression. 1
MIBG scan has a sensitivity of 83.3% and specificity of 98.0% for neuroblastoma diagnosis. 1
Complete blood count with differential and comprehensive metabolic panel. 1
Clinical Pitfall to Avoid
Hypertension in neuroblastoma is often severe but asymptomatic, so do not be falsely reassured by the absence of symptoms. 5 The hypertension can be labile and multi-drug resistant, particularly during chemotherapy when tumor lysis may cause catecholamine release. 2