Neuroblastoma is an uncommon malignancy in adult life as compared with childhood. A case of Stage IV neuroblastoma in a 24-year-old Chinese man seen at the University Hospital, Kuala Lumpur is reported. The diagnosis was based on characteristic histological features seen in an excised lymph node with metastatic involvement and an elevated urinary metanephrine level. The finding of a suprarenal mass on computerised axial tomographic scan supported an adrenal origin. Other diagnostic aids which help to distinguish this tumour, especially the less differentiated forms, from other "small, dark, round cell tumours" are discussed.