A 2-year-old boy has abdominal distension with a mass crossing the midline, proptosis with periorbital ecchymoses, and hypertension. Bone marrow aspirate shows small round blue cells forming rosettes. Urinary vanillylmandelic acid is elevated. The most likely primary site is:

• A Pancreas
• B Kidney
• C Liver
• D Adrenal gland ✓

Explanation

Neuroblastoma arises from neural crest cells of the sympathetic chain, and the adrenal medulla is the single most common primary site, followed by paraspinal ganglia. Features here are characteristic: a mass that crosses the midline (unlike Wilms tumour, which stays intrarenal), raccoon eyes from orbital metastasis, catecholamine metabolites such as VMA and HVA in urine, and Homer Wright rosettes on marrow examination. The kidney is the primary site of Wilms tumour, not neuroblastoma.

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

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Written and medically reviewed by the StethoPrep medical team.