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:
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
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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