NF1 and metastatic neoplasm: By contrast, pediatric PPGL in NF-1 is far less commonly seen, with reports indicating that these patients comprise only 1-3% of pediatric PPGL cohorts and present as teenagers (15-17 years), though 3 of 8 patients developed metastatic disease (one of which had microscopic residual tumor on histopathological analysis) (2, 4, 7).