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
- 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”