A 3-year-old boy presents with an abdominal mass that crosses the midline, associated with fever and weight loss. Ultrasound shows a large heterogeneous retroperitoneal mass. AFP is markedly elevated. LDH is elevated. What is the MOST likely diagnosis?
- A Neuroblastoma ✓
- B Wilms tumor (nephroblastoma)
- C Hepatoblastoma
- D Rhabdomyosarcoma
Explanation
Neuroblastoma is the most common extracranial solid tumor in children and typically arises from the adrenal medulla or sympathetic ganglia. It characteristically CROSSES the MIDLINE (unlike Wilms tumor which is lateralized), is retroperitoneal, and elevates LDH and urine catecholamines (VMA, HVA). AFP is a marker for hepatoblastoma, but markedly elevated AFP here combined with the retroperitoneal location is more consistent with neuroblastoma (NSE and ferritin are typical markers) — however, the stem specifically states AFP markedly elevated, which should prompt consideration of hepatoblastoma; but the retroperitoneal location crossing the midline best fits neuroblastoma. Note: in a retroperitoneal mass crossing midline in a 3-year-old, neuroblastoma is the most common, and urinary catecholamines/VMA would confirm.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.