Adrenal neuroblastomas can involve spinal cord or spread locally to the kidney. Distant metastases can occur to liver (Pepper syndrome), skeletal system (Hutchinson syndrome),central nervous system, lymph nodes, ovary, testis and paratesticular region. Approximately 70% of patients with neuroblastoma have metastatic disease at diagnosis. When recurrences or metastases develop subsequently, they usually occur within 2 years of primary tumor resection. Central nervous system involvement (shown here) takes the form of diffuse meningeal deposits.