Orbital neuroblastoma metastasis
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Neuroblastomas are the most frequently identified extracranial tumors that affect children under the age of 4 years old, with an incidence of approximately 1 to 3 in 100,000 cases. These account for approximately 6% to 10% of all pediatric tumors and 15% of tumor-related deaths in children.

A 3-year-old girl was admitted to our hospital presenting with periorbital ecchymoses and proptosis for 40 days. On examination, multiple hard masses were palpated on both the face and head. Bilateral subconjunctival hemorrhages, periorbital ecchymoses (raccoon eyes), and proptosis were identified. Fundus fluorescein angiography (FFA) and macular optical coherence tomography (OCT) revealed no abnormality on the fundus.

The systemic evaluations, which included routine blood and urine tests, hepatic and renal function examinations, and the serum glucose test, revealed unremarkable findings, with the exception of anemia. The electrocardiogram and chest roentgenogram results were also unremarkable. However, an abdominal mass was palpated by a pediatrician.

The computed tomography (CT) scan highlighted multiple soft tissue masses in the skull and both orbits, with evident erosion into the adjacent bones. The magnetic resonance imaging (MRI) also revealed multiple masses in the head-face area, and a large mass in the left suprarenal gland. The abdominal sonography examination revealed a heterogeneous hypoechoic mass in the left adrenal gland.

Source: Medicine: September 2019 - Volume 98

Read more: https://journals.lww.com/md-journal/Pages/articleviewer.aspx?year=2019&issue=09060&article=00035&type=Fulltext