Tom 17, Nr 6 (2023)
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Opublikowany online: 2023-12-21
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Eksport do Mediów Społecznościowych

Eksport do Mediów Społecznościowych

A walk through the minefield — when paediatric orthopaedics meets oncology

Marcin Karlikowski1
Forum Medycyny Rodzinnej 2023;17(6):261-270.


Introduction: The key, but at the same the least reliable element of the diagnostic process in modern oncology continues to be the physician, who — armed only in his suspiciousness and clinical experience — makes the preliminary diagnosis of a neoplastic disease. The objective of the present paper is to bring closer the problems inherent in a preliminary diagnosis of oncological diseases of the osteoarticular system in children and adolescents; the addressees of the report are predominantly physicians who are daily not involved in paediatric orthopaedics: family physicians, paediatricians, hospital emergency physicians — in other words, all the representatives of medical staff that have to exhibit particular vigilance during the first contact with a suffering child. Material and methods: Based on the collected material, the study presents diagnostic errors encountered in the diagnostic management of oncological diseases of the locomotor organs in children and adolescents. To illustrate the problem, a selection of treated patients is used, in whom incorrectness of the diagnostic process was identified. Results: Based on the available literature and the authors’ clinical experience, the attempt was to formulate a set of simple recommendations to be employed in everyday clinical practice.

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  1. Paredes-Aguilera R, Romero-Guzman L, Lopez-Santiago N, et al. Biology, clinical, and hematologic features of acute megakaryoblastic leukemia in children. Am J Hematol. 2003; 73(2): 71–80.
  2. Athale UH, Kaste SC, Razzouk BI, et al. Skeletal manifestations of pediatric acute megakaryoblastic leukemia. J Pediatr Hematol Oncol. 2002; 24(7): 561–565.
  3. Jalal H, Belhadj Z, Enneddam H, et al. Contribution of magnetic resonance imaging in the diagnosis of talus skip metastases of Ewing's sarcoma of the calcaneus in a child: a case report. J Med Case Rep. 2011; 5: 451.
  4. Caro-Domínguez P, Navarro OM. Bone tumors of the pediatric foot: imaging appearances. Pediatr Radiol. 2017; 47(6): 739–749.
  5. Cottias P, Tomeno B, Anract P, et al. Subacute osteomyelitis presenting as a bone tumour. A review of 21 cases. Int Orthop. 1997; 21(4): 243–248.
  6. McCarville MB, Chen JY, Coleman JL, et al. Distinguishing osteomyelitis from ewing sarcoma on radiography and MRI. AJR Am J Roentgenol. 2015; 205(3): 640–50; quiz 651.
  7. Bisogno G, Compostella A, Ferrari A, et al. Rhabdomyosarcoma in adolescents: a report from the AIEOP Soft Tissue Sarcoma Committee. Cancer. 2012; 118(3): 821–827.
  8. Kim JR, Yoon HM, Koh KN, et al. Rhabdomyosarcoma in children and adolescents: patterns and risk factors of distant metastasis. AJR Am J Roentgenol. 2017; 209(2): 409–416.
  9. Sarkar D, Ray S, Saha M, et al. Alveolar rhabdomyosarcoma with multiple distal metastases. A case report and review of literature. BMJ Case Rep. 2012; 2012.
  10. Livingood WC, Smotherman C, Lukens-Bull K, et al. An elephant in the emergency department: symptom of disparities in cancer care. Popul Health Manag. 2016; 19(2): 95–101.
  11. Roskin J, Diviney J, Nanduri V. Presentation of childhood cancers to a paediatric shared care unit. Arch Dis Child. 2015; 100(12): 1131–1135.
  12. Gerrand C, Francis M, Dennis N, et al. Routes to diagnosis for sarcoma — Describing the sarcoma patient journey. Eur J Surg Oncol. 2015; 41(10): 1393–1399.
  13. Mostoufi-Moab S, Halton J. Bone morbidity in childhood leukemia: epidemiology, mechanisms, diagnosis, and treatment. Curr Osteoporos Rep. 2014; 12(3): 300–312.
  14. Cohan N, Sarikhani S, Moslemi S, et al. Initial presentation of acute lymphoblastic leukemia with osteoporosis and multiple spontaneous bone fractures. Iran Red Crescent Med J. 2011; 13(1): 52–54.
  15. Sinigaglia R, Gigante C, Bisinella G, et al. Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 2008; 28(1): 20–28.
  16. Dayal R, Agarwal D. Fever in Children and Fever of Unknown Origin. Indian J Pediatr. 2016; 83(1): 38–43.
  17. Krych A, Odland A, Rose P, et al. Oncologic conditions that simulate common sports injuries. J Am Acad Orthop Surg. 2014; 22(4): 223–234.
  18. Interiano RB, Malkan AD, Loh AHP, et al. Initial diagnostic management of pediatric bone tumors. J Pediatr Surg. 2016; 51(6): 981–985.
  19. Tallen G, Bielack S, Henze G, et al. Musculoskeletal pain: a new algorithm for differential diagnosis of a cardinal symptom in pediatrics. Klin Padiatr. 2014; 226(2): 86–98.
  20. Parida L, Fernandez-Pineda I, Uffman J, et al. Clinical management of Ewing sarcoma of the bones of the hands and feet: a retrospective single-institution review. J Pediatr Surg. 2012; 47(10): 1806–1810.
  21. McCarville MB. The child with bone pain: malignancies and mimickers. Cancer Imaging. 2009; 9 Spec No A(Special issue A): S115–S121.
  22. Dhanoa A, Singh VA. Subacute osteomyelitis masquerading as primary bone sarcoma: report of six cases. Surg Infect (Larchmt). 2010; 11(5): 475–478.
  23. Samsudin EZ, Kamarul T, Mansor A. Avoiding diagnostic pitfalls in mimics of neoplasia: the importance of a comprehensive diagnostic approach. Singapore Med J. 2015; 56(5): e92–e95.
  24. Chen J, Mullen CA. Patterns of diagnosis and misdiagnosis in pediatric cancer and relationship to survival. J Pediatr Hematol Oncol. 2017; 39(3): e110–e115.
  25. Weiser P. Approach to the patient with noninflammatory musculoskeletal pain. Pediatr Clin North Am. 2012; 59(2): 471–492.
  26. Levy AD, Manning MA, Miettinen MM. Soft-tissue sarcomas of the abdomen and pelvis: radiologic-pathologic features, part 2-uncommon sarcomas. Radiographics. 2017; 37(3): 797–812.
  27. Swinson S, McHugh K. Urogenital tumours in childhood. Cancer Imaging. 2011; 11 Spec No A(1A): S48–S64.
  28. Singapore Cancer Network (SCAN) Sarcoma Workgroup. Singapore Cancer Network (SCAN) Guidelines for the Initial Evaluation, Diagnosis, and Management of Extremity Soft Tissue Sarcoma and Osteosarcoma. Ann Acad Med Singap. 2015; 44(10): 474–483.