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Pediatric update #16. The orthopaedic presentation of neuroblastoma
1Department of Orthopedic Surgery, University of Texas Southwestern Medical Center, Dallas.
Insights
Neuroblastoma in children can initially present as orthopedic issues, often misdiagnosed. Pronounced anemia, indicated by low hemoglobin levels, is a key indicator of this childhood cancer.
Area of Science:
- Pediatric Oncology
- Orthopedics
- Hematology
Background:
- Neuroblastoma is a common childhood cancer.
- Orthopedic complaints are an infrequent initial presentation of neuroblastoma.
- Misdiagnosis of orthopedic symptoms can delay cancer diagnosis.
Purpose of the Study:
- To investigate orthopedic presentations of neuroblastoma in children.
- To identify diagnostic clues for neuroblastoma presenting with orthopedic symptoms.
- To differentiate anemia associated with neuroblastoma from other conditions.
Main Methods:
- Retrospective review of 109 children with neuroblastoma over eight years.
- Categorization of orthopedic complaints: hip pain, limp, limb weakness, back pain.
- Comparison of laboratory findings, particularly hemoglobin levels, with septic arthritis cases.
Main Results:
- Twenty of 109 children (18%) initially presented with orthopedic complaints.
- Hip pain was the most common orthopedic complaint, frequently misdiagnosed as septic arthritis.
- Children with neuroblastoma exhibited more pronounced anemia compared to those with septic arthritis.
Conclusions:
- Orthopedic symptoms can be the initial manifestation of neuroblastoma in children.
- Anemia, specifically a pronounced drop in hemoglobin, is a critical early indicator of malignancy.
- Increased awareness and consideration of neuroblastoma in children with unexplained orthopedic symptoms and anemia are crucial for timely diagnosis.
Abstract:
Twenty of 109 children (age, one day to 14 years) with neuroblastoma studied over an eight-year period initially presented with orthopaedic complaints. Patients were grouped into four categories: hip pain, a nonspecific limp, limb weakness, or back pain. The largest group involved the hip, and their conditions were most often misdiagnosed as suppurative arthritis. The initial hemoglobin level was the most consistent laboratory finding that suggested malignancy. This anemia was contrasted to that found in 74 children diagnosed with septic arthritis of the hip that presented during the same period. The anemia in the children with neuroblastoma was much more pronounced; in retrospect, it could have suggested a malignant process early in the evaluation.
