Metastases 7341 Metastatic Sites

Metastases are non-randomly distributed and the pattern differs distinctly between the mainly progressive stage 4 and the mainly regressive stage 4S (Table 7.4). Major metastatic sites in stage-4 disease include bone marrow, bone, and lymph nodes, while liver, skin, and bone marrow are common metastatic sites in stage-4S infants. By definition, infants with stage-4S disease do not have bone involvement. The preference of the bony metastases to facial bones, including the orbits, may be related to their neural crest origin (de la Monte et al. 1983).

The site of recurrence may depend on the type of the preceding treatment. For example, with the infu

Table 7.4. Localization of metastases in patients with neuroblastoma stage 4 and stage 4S at diagnosis and at first recurrence

Disease localization

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