Which orbital tumor is the most common secondary pediatric orbital malignancy and commonly arises from a tumor in the abdomen, mediastinum, or neck?

• A. Neuroblastoma
• B. Rhabdomyosarcoma
• C. Cavernous hemangioma
• D. Meningioma

Answer: (A)

Neuroblastoma is the most common source of metastatic disease to the orbit in children. It originates from neural crest cells and often starts outside the spine in the abdomen (most often the adrenal glands), but it can also arise in the mediastinum or neck. Because it spreads through the bloodstream, orbital involvement is a frequent site of metastasis, making it the leading cause of a secondary pediatric orbital malignancy. Clinically, orbital metastasis from neuroblastoma can cause rapid-onset proptosis, eyelid swelling, and sometimes displacement of the globe.

Rhabdomyosarcoma is the most common primary pediatric orbital malignancy, meaning it begins in the orbit rather than spreading to it. Cavernous hemangioma is a benign vascular tumor and not a malignant metastasis. Meningioma is relatively rare in children and not a common source of orbital metastasis.