[Osteoarticular changes in childhood leukemia, lymphoma and neuroblastoma]

Osteoarticular changes may occur in up to 23% of the cases with Acute Lymphoblastic Leukemia (ALL) and even more frequent with Acute Myeloblastic Leukemia (AML). Most of the bone and joint pains are due to neoplastic infiltration, radiologically obvious as metaphyseal clear stripes, parietal enlargement, periosteal reaction, osteolysis and diffuse osteoporosis in the long bone. In Malignant Lymphomas (ML) the bone involvement is rarer, usually bone metastases identifiable with Tc scintigraphy being the cause. In Neuroblastoma (Nbl) cases, bone metastases are commonly associated with abdominal tumor beyond one year of age. Of the total ALL, AML, ML and Nbl cases treated in our Oncology Dept, we selected 43 children with osteoarticular involvement. The sex ratio was 24 boys to 19 girls and the specific malignancy was ALL in 25 cases, AML in 5 cases, ML in 2 cases and Nbl in 10 cases. The following biological parameters were monitored: type of onset, the localization and nature of the bone affectation, differential diagnosis, and the response to therapy. The presence of the osteoarticular involvement has proved to be of no prognostic significance. The spectrum of clinical manifestations varied from mild pain to severe disability, in 7% of the cases being the unique symptoms. The type of lesion did not rise important differential diagnosis issues, excepting the cases with unique osteolytic lesion or diffuse osteoporosis, where the rest of the data and the elevated urine vanilmandelic acid helped to establishing the diagnosis. We conclude that the osteoarticular involvement encountered in different malignancies in children is a major sources of diagnostic problems, but it is not associated with a significant outcome.