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Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications.
Rev Bras Reumatol Engl Ed. 2017 Jul - Aug; 57(4):330-337.RB

Abstract

OBJECTIVE

To assess the prevalence and describe the clinical, laboratory and radiological findings, treatment and outcome of children with cancer initially referred to a tertiary outpatient pediatric rheumatology clinic.

METHODS

Retrospective analysis of medical records from patients identified in a list of 250 new patients attending the tertiary Pediatric Rheumatology Clinic, Ribeirão Preto Medical School hospital, University of São Paulo, from July 2013 to July 2015, whose final diagnosis was cancer.

RESULTS

Of 250 patients seen during the study period, 5 (2%) had a cancer diagnosis. Among them, 80% had constitutional symptoms, especially weight loss and asthenia, and 60% had arthritis. Initially, all patients had at least one alteration in their blood count, lactate dehydrogenase was increased in 80% and a bone marrow smear was conclusive in 60% of patients. Bone and intestine biopsies were necessary for the diagnosis in 2 patients. JIA was the most common initial diagnosis. The definitive diagnosis was acute lymphoblastic leukemia (2 patients), M3 acute myeloid leukemia, lymphoma, and neuroblastoma (one case each). Of 5 patients studied, 3 (60%) are in remission and 2 (40%) died, one of them with prior use of steroids.

CONCLUSION

The constitutional and musculoskeletal symptoms common to rheumatic and neoplastic diseases can delay the diagnosis and consequently worsen the prognosis of neoplasms. Initial blood count and bone marrow smear may be normal in the initial framework of neoplasms. Thus, the clinical follow-up of these cases becomes imperative and the treatment, mainly with corticosteroids, should be delayed until diagnostic definition.

Authors+Show Affiliations

Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Hospital das Clínicas, Ribeirão Preto, SP, Brazil.Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Hospital das Clínicas, Ribeirão Preto, SP, Brazil.Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Hospital das Clínicas, Ribeirão Preto, SP, Brazil.Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Hospital das Clínicas, Ribeirão Preto, SP, Brazil.Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil.Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil.Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, SP, Brazil.Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Hospital das Clínicas, Ribeirão Preto, SP, Brazil. Electronic address: Lucianamc2503@gmail.com.

Pub Type(s)

Journal Article

Language

eng por

PubMed ID

28743360

Citation

Fonseca, Mariana Bertoldi, et al. "Signs and Symptoms of Rheumatic Diseases as First Manifestation of Pediatric Cancer: Diagnosis and Prognosis Implications." Revista Brasileira De Reumatologia, vol. 57, no. 4, 2017, pp. 330-337.
Fonseca MB, Gomes FHR, Valera ET, et al. Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications. Rev Bras Reumatol Engl Ed. 2017;57(4):330-337.
Fonseca, M. B., Gomes, F. H. R., Valera, E. T., Pileggi, G. S., Gonfiantini, P. B., Gonfiantini, M. B., Ferriani, V. P. L., & Carvalho, L. M. (2017). Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications. Revista Brasileira De Reumatologia, 57(4), 330-337. https://doi.org/10.1016/j.rbre.2017.01.007
Fonseca MB, et al. Signs and Symptoms of Rheumatic Diseases as First Manifestation of Pediatric Cancer: Diagnosis and Prognosis Implications. Rev Bras Reumatol Engl Ed. 2017 Jul - Aug;57(4):330-337. PubMed PMID: 28743360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Signs and symptoms of rheumatic diseases as first manifestation of pediatric cancer: diagnosis and prognosis implications. AU - Fonseca,Mariana Bertoldi, AU - Gomes,Francisco Hugo Rodrigues, AU - Valera,Elvis Terci, AU - Pileggi,Gecilmara Salviato, AU - Gonfiantini,Paula Braga, AU - Gonfiantini,Marcela Braga, AU - Ferriani,Virgínia Paes Leme, AU - Carvalho,Luciana Martins de, Y1 - 2017/02/10/ PY - 2016/06/01/received PY - 2016/11/08/accepted PY - 2017/7/27/entrez PY - 2017/8/16/pubmed PY - 2019/8/21/medline KW - Artrite idiopática juvenil KW - Doenças reumáticas, Pediatria KW - Juvenile idiopathic arthritis KW - Musculoskeletal symptoms KW - Neoplasia KW - Neoplastic diseases KW - Pediatric rheumatic disease KW - Sintomas musculoesqueléticos SP - 330 EP - 337 JF - Revista brasileira de reumatologia JO - Rev Bras Reumatol Engl Ed VL - 57 IS - 4 N2 - OBJECTIVE: To assess the prevalence and describe the clinical, laboratory and radiological findings, treatment and outcome of children with cancer initially referred to a tertiary outpatient pediatric rheumatology clinic. METHODS: Retrospective analysis of medical records from patients identified in a list of 250 new patients attending the tertiary Pediatric Rheumatology Clinic, Ribeirão Preto Medical School hospital, University of São Paulo, from July 2013 to July 2015, whose final diagnosis was cancer. RESULTS: Of 250 patients seen during the study period, 5 (2%) had a cancer diagnosis. Among them, 80% had constitutional symptoms, especially weight loss and asthenia, and 60% had arthritis. Initially, all patients had at least one alteration in their blood count, lactate dehydrogenase was increased in 80% and a bone marrow smear was conclusive in 60% of patients. Bone and intestine biopsies were necessary for the diagnosis in 2 patients. JIA was the most common initial diagnosis. The definitive diagnosis was acute lymphoblastic leukemia (2 patients), M3 acute myeloid leukemia, lymphoma, and neuroblastoma (one case each). Of 5 patients studied, 3 (60%) are in remission and 2 (40%) died, one of them with prior use of steroids. CONCLUSION: The constitutional and musculoskeletal symptoms common to rheumatic and neoplastic diseases can delay the diagnosis and consequently worsen the prognosis of neoplasms. Initial blood count and bone marrow smear may be normal in the initial framework of neoplasms. Thus, the clinical follow-up of these cases becomes imperative and the treatment, mainly with corticosteroids, should be delayed until diagnostic definition. SN - 2255-5021 UR - https://www.unboundmedicine.com/medline/citation/28743360/Signs_and_symptoms_of_rheumatic_diseases_as_first_manifestation_of_pediatric_cancer:_diagnosis_and_prognosis_implications_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2255-5021(17)30007-X DB - PRIME DP - Unbound Medicine ER -