10.6.2 Symptoms Associated with Catecholamine Production

•Paroxysmal attacks of sweating, flushing, pallor

•Headache

•Hypertension

•Palpitations

•VIP (Vasoactive Intestinal Peptides by high level of catecholamines) syndrome: untreatable diarrhea and low level of potassium caused by VIP in 5–10% of children

10.6.3 Paraneoplastic Syndromes

• Opsoclonus: occurring mostly in well-differentiated neuroblastoma

• Occasionally, anemia in children with bone marrow infiltration (associated with thrombocytopenia and leukocytopenia) or in children with massive intratumoral hemorrhage can be seen

10.6.4 Local Symptoms and Classic Signs

10.6.4.1 Eyes

• Periorbital edema, swelling, and yellow–brown ecchymoses (aka raccoon eyes)

• Proptosis and exophthalmos, strabismus, opsoclonus

• Papillary edema, bleeding of the retina, atrophy of the optic nerve

10.6.4.2 Neck

•Cervical lymphadenopathy

•Supraclavicular tumor

•Horner syndrome: enophthalmos, miosis, ptosis, anhydrosis

10.6.4.3Chest, Posterior Mediastinum, and Vertebrae

• Compression of trachea: coughing, dyspnea

• Infiltration in intervertebral foramina: dumbbell tumor

• Compression of nerves: disturbances of gait, muscle weakness, paresthesia, bladder dysfunction, constipation (the latter symptoms indicate that emergency decompression is necessary)

10.6.4.4Abdomen

•Retroperitoneal: intra-abdominal tumor, often firm on palpation; irregular mass, often crossing the midline

•Paravertebral and presacral: tendency to grow into the intravertebral foramina, causing neurological dysfunction

•Occasionally abdominal distension

•Pelvic tumor: bladder or bowel compression