Metastatic Neuroblastoma with Initial Orbital Presentation

Neuroblastoma, also called sympathoblastoma, is a malignant embryonal tumor developed at the expense of neural crest cells, the most frequent solid tumor in children under 5 years of age. The objective is to recall the clinical variability and the importance of evoking neuroblastoma in a child presenting with an ophthalmological symptom. We report the case of a 5-year-old child who presented with a right orbital metastatic neuroblastoma, whose ophthalmologic complaint led to the diagnosis. An ophthalmologist in the emergency room for a VAD and eye pain first saw the child. On examination, true exophthalmos with palpebral edema was found on the right. Cerebral and orbital CT revealed a right latero-orbital osteolytic mass of secondary appearance with endocranial extension. The workup showed lymph node involvement, unilateral right adrenal, osteomedullary, hepatic, and pancreatic involvement. The child was admitted to a specialized pediatric oncology department and received chemotherapy. The patient was then declared under palliative treatment.