A 2-year-old presents with proptosis, orbital ecchymosis ('raccoon eyes'), a palpable abdominal mass and bone pain. Urine vanillylmandelic acid (VMA) is markedly elevated. The diagnosis is:

• A Wilms tumor with metastasis
• B Retinoblastoma with orbital extension
• C Neuroblastoma with orbital metastasis ✓
• D Rhabdomyosarcoma

Explanation

Neuroblastoma is the most common extracranial solid tumor in children <5 years, arising from neural crest cells (adrenal medulla/sympathetic chain). It metastasizes early to orbital fat, causing bilateral periorbital ecchymosis (raccoon/panda eyes/Hutchinson sign) and proptosis — highly characteristic. Urine catecholamine metabolites (VMA, HVA) are elevated in >90% of cases and serve as tumor markers. Wilms tumor causes abdominal mass but not periorbital ecchymosis. Retinoblastoma presents with leukocoria. Rhabdomyosarcoma has no catecholamine secretion.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.