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Solid tumours in children
Brain tumours are the commonest solid tumours in children, and outside the brain — neuroblastoma; most tumours are recognised by age and site: an abdominal mass crossing the midline in a toddler is neuroblastoma, a renal mass that does not cross is Wilms, leucocoria is retinoblastoma, and night bone pain in an adolescent — osteosarcoma or Ewing sarcoma.
Why it matters in the exam
The classic question compares neuroblastoma with Wilms tumour. Neuroblastoma: a child under 5, an irregular mass crossing the midline with calcifications, an ill child, raised urinary catecholamines (VMA, HVA), and sometimes periorbital bruising, opsoclonus-myoclonus or Horner syndrome; MYCN amplification predicts a poor prognosis. Wilms: a well-looking 3–4-year-old, a smooth mass that does not cross the midline, sometimes haematuria and hypertension; it is not palpated repeatedly so as not to rupture the capsule.
Wilms is linked to syndromes: WAGR, Denys-Drash and Beckwith-Wiedemann and hemihypertrophy — in which abdominal ultrasound is done every 3 months until age 7–8. The prognosis of Wilms is excellent. Retinoblastoma presents as leucocoria (a "white pupil" in a photograph) or squint; bilateral disease is hereditary (RB1) and raises the later risk of osteosarcoma. Brain tumours in children are mostly in the posterior fossa — medulloblastoma and pilocytic astrocytoma — and present as morning headache with vomiting and ataxia.
In bone tumours: osteosarcoma in the metaphysis of long bones around the knee in adolescents, with a "sunburst" pattern and Codman triangle on X-ray; Ewing sarcoma in the diaphysis or pelvis, with an "onion skin" pattern, fever and systemic signs, and t(11;22). Rhabdomyosarcoma appears in the head and neck or the genitourinary tract (sarcoma botryoides). Bone pain that wakes from sleep, weight loss or a growing mass needs imaging, not a label of "growing pains".
Key points
- Brain tumours are the commonest solid tumours in children; outside the brain — neuroblastoma.
- Neuroblastoma: crosses the midline, urinary catecholamines, MYCN.
- Wilms: a smooth renal mass in a well-looking child.
- Leucocoria = retinoblastoma.
- Osteosarcoma in the metaphysis; Ewing in the diaphysis with onion skin.
Summary table
| Tumour | Age and site | Pointing finding | Note |
|---|---|---|---|
| Neuroblastoma | Under 5, adrenal or sympathetic chain | Crosses the midline, calcifications, urinary VMA and HVA, periorbital bruising | MYCN amplification — poor prognosis |
| Wilms | 3–4, kidney | Smooth mass not crossing the midline, child looks well, haematuria, hypertension | WAGR, Beckwith-Wiedemann; do not palpate repeatedly |
| Retinoblastoma | Under 5, eye | Leucocoria, squint | Bilateral = hereditary (RB1) |
| Brain tumours | Posterior fossa in children | Morning headache, vomiting, ataxia | The commonest solid tumours |
| Osteosarcoma | Adolescents, metaphysis around the knee | Sunburst, Codman triangle | Night pain, mass |
| Ewing sarcoma | Children and adolescents, diaphysis and pelvis | Onion skin, fever, t(11;22) | Mimics osteomyelitis |
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Sources
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Neuroblastoma; Neoplasms of the Kidney; Retinoblastoma; Brain Tumors in Childhood; Malignant Tumors of Bone
- Pizzo and Poplack's Principles and Practice of Pediatric Oncology, 8th edition (2021) — Clinical presentation of childhood solid tumours
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.