Anatomic Site

Clinical manifestations depend on the anatomic site of the primary tumor:

1. Head and neck: Unilateral palpable mass

Horner syndrome (meiosis, ptosis, enophthalmos, anhydrosis)

2. Orbit and eye:

Orbital secondaries with periorbital hemorrhage ("raccoon eyes") Exophthalmos, palpable supraorbital masses, ecchymosis, edema of eyelids and conjunctiva, ptosis

Cerebral involvement: papilledema, retinal hemorrhage, optic atrophy, paresis of the external rectus muscle, and strabismus

Cervical sympathetic involvement: heterochromia iridis, anisocoria, Horner syndrome

Opsoclonus ("dancing eyes syndrome")

Upper thoracic tumors: dyspnea, pulmonary infections, dysphagia, lymphatic compression, Horner syndrome

Lower thoracic tumors: usually no symptoms

4. Abdomen: Anorexia, vomiting Abdominal pain Palpable mass

Massive involvement of the liver with metastatic disease with or without respiratory distress especially in the newborn

5. Pelvis: Constipation Urinary retention

Presacral mass palpable on rectal examination

6. Paraspinal area (dumbbell- or hourglass-shaped neuroblastoma): Localized back pain and tenderness


Weakness of lower extremities

Hypotonia, muscle atrophy, areflexia, or hyperreflexia of lower extremities



Bladder and anal sphincter dysfunction

7. Lymph nodes: enlarged

8. Bone: pain, limping, and irritability in the young child associated with bone and bone marrow metastases.

9. Lung: lungs and pleura are rarely involved; incidence of 0.7% in all patients with neuroblastoma; because of its rarity, lung involvement should be proven by biopsy

10. Brain: rarely, metastatic involvement of the brain can occur.

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Constipation Prescription

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