Pediatric Rheumatology Online Journal → August 2003 → Miscellaneous Clinical Studies and Case Reports → Abstract #190

FREQUENCY OF MALIGNANCY IN CHILDREN REFERED TO A PEDIATRIC RHEUMATOLOGY UNIT

M. T. Terreri,¹ M. Goncalves,¹ C. Passarelli,¹ M. L. Lee,² C. A. Len,¹ M. O. Hilario.¹

¹Pediatric Rheumatology Unit - Department of Pediatrics, Universidade Federal de Sao Paulo - EPM, Sao Paulo, SP, Brazil; ²Pediatric Oncology Unit - Department of Pediatrics, Universidade Federal de Sao Paulo - EPM, Sao Paulo, SP, Brazil

OBJECTIVES: To assess the frequency, the clinic characteristics and types of cancer manifestated in children presenting to our Pediatric Rheumatologic Clinic with musculoskeletal complaints over a 7-year-period.
METHODS: The medical records of patients with musculoskeletal complaints and a final diagnosis of cancer were retrospectively reviewed. In each case were assessed: initial age of the symptoms, age at the diagnosis, presenting clinical features, laboratory findings and initial and final diagnosis.
RESULTS: The final diagnosis of cancer was found in 9 out of 3528 patients (0,3%) whose initial symptoms were musculoskeletal pain. The mean age at the disease onset was 6 years and 5 months. The mean time between disease onset and final diagnosis was 5 months. The most common presenting feature was pauciarticular arthritis or arthralgia, involving the larger joints. Juvenile rheumatoid arthritis was the most frequent initial diagnosis in (7/9 [78%> patients). The initial hematologic evaluation showed in 6 of 9 patients a decreased hemoglobin, lower than 11 mg/dl; only 1 patient presented an increased white blood cell count and none of them a decreased white blood cell count. Six of 8 patients (75%) had an increased erythrocyte sedimentation rate. Lactate dehydrogenase was raised in 5 of 8 patients (63%). To reach the final diagnosis, bone marrow aspirate and/or biopsy were necessary. The types of malignancies included acute lymphocytic leukemia (ALL) (4 cases), acute myeloblastic leukemia (AML) (2 cases) , lymphoma (1 case), neuroblastoma (1 case) and Ewing"s sarcoma (1 case).
CONCLUSION: Malignancy should always be excluded in children with musculoskeletal complaints. The incharacteristic clinical manifestations and inespecific laboratory tests may raise difficulties to the final diagnosis. Thus, everytime we suspect of any kind of malignancy, a rigorous attendance and adittional investigation should be performed, specially bone marrow aspirate and biopsy when necessary.