10.8.2 Other Laboratory Findings

• Serum ferritin level often high

• High level of lactate dehydrogenase (LDH) correlates with rapid tumor turnover

10.8.3 Bone Marrow

•Aspiration and biopsy at two or more locations for detection of bone marrow involvement should be part of metastatic workup

10.9Diagnostic Imaging

10.9.1 Conventional X-Ray

•Thoracic X-ray for mediastinal tumor

•Abdominal X-ray: often calcifications visible in the tumor

•Skeletal survey for cortical bone metastases (differential diagnosis): bone tumor, Langerhans histiocytosis, infectious disease of bone, battered-child syndrome, metastatic spread of other neoplasias

10.9.2 Methylisobenzyl Guanidinium (MIBG) Scintigraphy

•Radiolabeled specific and sensitive method for evaluation of the primary tumor and focal metastatic disease

10.9.3Ultrasound, Computed Tomography CT and/or MRI or PET/ CT, if Not Enough Information by MIBG Scan and Bone Scan

•These can provide detailed information on tumor size, extension, and metastases of abdominal, hepatic, skeletal, pulmonary, mediastinal, and central nervous system

10.9.4 Bone Scintigraphy (Technetium)

•Ten percent of patients have negative MIBG results of the bone examination, which can be detected by technetium bone scan