Neuroblastomadown arrow


Late Effects





Home > Disclaimer > Neuroblastoma





Metastatic Disease


NBL is associated with lymphatic and hematogenous metastatic disease.

Regional lymph node metastases are noted in 35% of patients with apparently localized tumors.

The most common sites for hematogenous spread are:

  • Bone marrow
  • Bone
  • Liver
  • Skin
  • Brain or lung (rare)



Signs and symptoms of NBL include:

Metastatic disease to bone can cause:

    • Pain and limping
    • Sphenoid bone and retrobulbar tissue involvement causes orbital ecchymoses swelling and proptosis (raccoon face)
    • Infants present as irritable and fussy

Bone marrow involvement may result in pancytopenia.

Respiratory distress may occur in young babies with Stage IVS disease - due to enlarged liver.

Skin or subcutaneous nodules are seen almost only in infants.  These nodules are non-tender, bluish and mobile - called the “blueberry muffin sign”






Back to top