Neuroblastoma Presenting as Ecchymosis of the Eyelids.

WITH the exception of leukaemia, neuroblastoma sympatheticum is the most frequently occurring malignant neoplasm in infancy and childhood (Bodian and White, 1952). It is classified with neurological tumours, because it originates from tissue which gives rise to the adrenal medulla and portions of the sympathetic system. The most common single site is the adrenal medulla (Willis, 1960), but it can arise from sympathetic tissue anywhere in the body. The main histological features are numerous cells, like lymphocytes, with a scanty stroma, rosette formation, and neurofibrils. Metastasis takes place by both lymphatic and, especially, blood stream invasion. Hutchison (1907) drew attention to his "clinical syndrome", describing seven cases of tumour of one or other adrenal with metastases in the bones of the skull. In two of his cases ecchymosis of the eyelids was the first physical sign. Bothman and Blankstein (1942), discussing the importance of ocular findings in neuroblastoma, reported four cases observed by them in 1936-37. 1n one of these, ecchymosis of an eyelid was the presenting sign. Despite this, it is not generally realized that neuroblastoma not infrequently presents as ecchymosis of the eyelids, as in the following case.