A 3-year-old child is found to have an abdominal mass crossing the midline on examination. Ultrasound shows a large renal mass with calcifications. Urine VMA/HVA ratio is 3:1 (HVA predominant). The MOST likely diagnosis is:

• A Wilms tumor (nephroblastoma)
• B Hepatoblastoma
• C Neuroblastoma ✓
• D Renal cell carcinoma

Explanation

Neuroblastoma arises from neural crest sympathetic precursors and classically presents with an abdominal mass crossing the midline (suprarenal origin), calcifications on imaging, and elevated urinary catecholamine metabolites — VMA (vanillylmandelic acid) and HVA (homovanillic acid). Wilms tumor (nephroblastoma) also causes a renal mass but is intrarenal, rarely crosses midline early, and does not elevate VMA/HVA. A HVA-predominant pattern with a VMA:HVA ratio < 1 (more HVA) actually suggests more aggressive/undifferentiated neuroblastoma.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.