Frequent Symptoms

Presenting signs and symptoms of children with neu-roblastoma reflect both the location of the primary tumor and the extent of disease. The typical patient with neuroblastoma is an infant or a toddler. Pain from abdominal distension or metastases to bone is common (30%). Many patients fail to gain weight or have weight loss (11%). The characteristic bilater al periorbital ecchymosis, which is a sign of meta-static disease, is typically caused by intraorbital masses.

In contrast, infants with stage 4S commonly present with abdominal distension resulting from massive liver infiltration (Fig. 7.1 a) and subcutaneous nodules (most of them better palpable than visible, sometimes blueberry appearance; Fig. 7.1b). The massive hepatomegaly can lead to respiratory distress, and kidney or bowel function can be impaired due to obstruction by the tumor. Their medical condition can rapidly deteriorate within hours or days (Berthold et al. 1990).

Table 7.1. Rare but characteristic symptoms of neuroblastoma (n=1878, trials NB90/97)



Occurrence (%)

5-year survival (%)a

Transverse myelopathy

Dumbbell tumor with intraspinal, extradural extension

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