A 3-year-old child is diagnosed with neuroblastoma after presenting with a mass in the abdomen, abnormal eye movements, and swelling of the face. Which of the following is the most common site of origin for neuroblastoma in children?

A. Liver is incorrect because the liver is not the primary site of neuroblastoma. While the liver can become involved through metastasis, the tumor originates elsewhere along the sympathetic chain. B. Brain is incorrect because neuroblastoma develops from peripheral sympathetic tissue, not the central nervous system. Brain tumors in children are a separate category of malignancies. C. Kidneys is incorrect. Although neuroblastoma can present as an abdominal mass that seems near the kidneys, the tumor originates from the adrenal glands, not the renal tissue itself. Wilms’ tumor, not neuroblastoma, arises from the kidneys in children. D. Adrenal glands is correct. Approximately 40% of neuroblastomas originate in the adrenal medulla, located above the kidneys. Other tumors may arise along the sympathetic chain, including the chest, neck, and pelvis. The adrenal origin explains why children may present with abdominal masses, abdominal pain, or systemic symptoms. Metastatic spread can cause periorbital ecchymosis (“raccoon eyes”), proptosis, and facial edema, as seen in this child, reflecting tumor spread to orbital bones and lymphatic structures.