Neuroblastoma: Viva

This is a branching oral built to probe the reasoning that holds the risk stratification and the paraneoplastic syndrome at the centre, and to expose the candidate who has memorised the headline without the safety-critical corners. The questions escalate from the framing to the staging, the molecular markers, the treatment pathway and the paraneoplastic syndrome, with deliberate probes into the spontaneous regression and the late effects. ^[1]

Opening question: framing the problem

The examiner opens with the mass and the periorbital ecchymosis and asks: how do you frame this problem in a single sentence, and what is your first step? ^[1]

A strong answer names the neuroblastoma from the abdominal mass crossing the midline, the catecholamine secretion and the periorbital ecchymosis of the orbital metastasis, and states that the first step is the confirmation of the catecholamine secretion and the staging of the disease extent. ^[1]

Model answer. This child has a metastatic neuroblastoma from the abdominal mass crossing the midline, the catecholamine secretion and the periorbital ecchymosis. The first step is to confirm the diagnosis with the urinary vanillylmandelic acid and homovanillic acid, to stage the disease with the iodine-123 metaiodobenzylguanidine scan and the magnetic resonance imaging, and to risk-stratify with the biopsy and the MYCN amplification status. ^[1][2]

Probe one: the staging system

The examiner presses: describe the International Neuroblastoma Risk Group staging system, and tell me what the image-defined risk factors are. ^[2]