A case of metastatic high grade neuroblastoma with undetected primary in adult presenting with soft tissue lumps and bilateral choroidal metastases

An adult male patient got hospitalized with fever, anorexia, weight loss, generalized weakness, and visual problem. Examination revealed solitary axillary lymphadenopathy and soft tissue swellings over scalp and left shoulder. Tests detected severe anemia and raised erythrocyte sedimentation rate (ESR), lactate dehydrogenase, and uric acid. Magnetic resonance imaging (MRI) brain showed irregular soft tissue swellings both outside and inside the skull with pressure effect on brain. Fundoscopy revealed bilateral choroidal metastatic deposits with papilledema. Histopathology findings of biopsy from scalp mass and bone marrow were consistent with metastatic high grade neuroblastoma. No primary lesion was found on computed tomography (CT) scan of thorax, abdomen, and pelvis. There was also suggestion of paraneoplastic neuropathy. The patient responded fairly to chemotherapy. Neuroblastoma is usually known to be a childhood malignancy that often presents with vague symptoms or symptoms due to tumor mass or with metastatic or paraneoplastic features. Most common metastatic sites are bone, lymph node, liver, cranium, and chest. But in this case apart from bony and dural metastases there was also choroidal metastasis which is previously not reported in adults. Likewise, non-detection of primary tumor is also uncommon.