An 11-Month-Old Boy Is Brought to the Office Due to Irregular

An 11-month-old boy is brought to the office due to irregular jerking movements.  His mother states that for 2 weeks he has looked pale and tired, and he has been more fussy and less playful than usual.  Temperature is 36.7 C (98 F) , blood pressure is 100/60 mm Hg, pulse is 114/min, and respirations are 16/min.  Physical examination reveals spontaneous bursts of nonrhythmic conjugate eye movements in various directions.  The patient also has myoclonus involving the trunk and limbs as well as generalized hypotonia.  A right-sided, nontender, immobile abdominal mass is palpated.  There is no hepatosplenomegaly, and bowel sounds are normal.  Complete blood count reveals anemia, and urine is positive for elevated levels of catecholamine breakdown products.  Which of the following is the most likely diagnosis?

A) Carcinoid tumor
B) Ewing sarcoma
C) Medulloblastoma
D) Neuroblastoma
E) Non-Hodgkin lymphoma
F) Pheochromocytoma
G) Wilms tumor

Correct Answer:

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