A 3-year-old boy has a firm abdominal mass. CT shows a mass arising from the left suprarenal region, extending across the midline, encasing vessels, and containing fine stippled calcification. Which additional finding would further support this diagnosis rather than a Wilms tumour?

• A Smooth surface and free mobility with respiration
• B Painless gross haematuria
• C Displacement of the kidney downwards with preservation of its shape
• D Raised urinary homovanillic acid and vanillylmandelic acid ✓

Explanation

Crossing the midline, vascular encasement and stippled calcification point to neuroblastoma arising from the adrenal medulla or sympathetic chain. Neuroblastoma catecholamine metabolites, HVA and VMA, are raised in urine, and their measurement supports the diagnosis. Haematuria, a smooth mobile mass that displaces but does not distort the kidney, and a mass that moves with respiration are all classic features of a Wilms tumour, which rarely calcifies and typically stays lateral to the midline.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.