Non-hematopoietic tumors can involve the bone marrow (BM). BM metastasis represents advanced-stage disease and is associated with inferior outcomes [1]. Examination of the BM is a common procedure in the initial evaluation of children with solid tumors for tumor staging, subsequent treatment monitoring, and documentation of recurrent disease [1]. Less frequently, it provides a diagnosis from an occult primary site. The frequency of BM metastasis depends on the tumor type. Neuroblastoma, Ewing sarcoma, and alveolar rhabdomyosarcoma are more frequently present with BM metastases, whereas metastases from other soft tissue sarcomas, brain tumors, retinoblastomas, and hepatoblastomas are much less common. Some tumors, such as Wilms tumor, almost never metastasize to the BM and do not require BM examination in general.

Clinical presentations of solid tumor metastasis to the BM are variable. Bone pain, pathologic fractures, and cytopenia are frequently recorded, but they are non-specific.