Department of Pediatric Oncology/Hematology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Eur Child Adolesc Psychiatry. 2013 Jul;22(7):443-50. doi: 10.1007/s00787-012-0349-7. Epub 2013 Jan 8.
A somatic disorder may initially be overlooked when a child presents with psychiatric symptoms. We report two children with anorexia nervosa as initial diagnosis and in whom there was a delay in the final diagnosis of the underlying malignancy. A literature survey was performed including patients under 18 years of age with psychiatric symptoms in whom later on an oncological diagnosis became evident as an explanation.
We have found 30 additional cases, with a median delay of 12 months until the diagnosis of the tumour. Overall, 16 boys and 16 girls had a solid tumour: 26 central nervous system tumours, 3 tumours of the gastrointestinal tract and 3 others. In 25 out of 32 patients anorexia nervosa was assumed, although it always appeared to be atypical. Patients younger than 7 years had a significantly longer delay until final diagnosis, while no other patient characteristics correlated with such delay.
In addition to careful physical (including full neurological) examination, we advise additional neuroimaging especially in each case of atypical presentation of anorexia nervosa, in order to avoid a delay in diagnosis of a possible malignancy. Furthermore, it is desirable to perform a re-examination when a psychiatric disorder does not respond to therapy, in order not to overlook an underlying oncological disease.
当儿童出现精神症状时，最初可能会忽略躯体疾病。我们报告了两例以神经性厌食症为初始诊断的儿童，其潜在恶性肿瘤的最终诊断被延迟。进行了一项文献调查，包括年龄在 18 岁以下有精神症状的患者，后来发现肿瘤是其病因。
我们又发现了 30 例病例，肿瘤诊断的平均延迟时间为 12 个月。总体而言，16 名男孩和 16 名女孩患有实体瘤：26 例中枢神经系统肿瘤、3 例胃肠道肿瘤和 3 例其他肿瘤。尽管厌食症表现不典型，但在 32 例患者中有 25 例被误诊为厌食症。年龄小于 7 岁的患者最终诊断的延迟时间明显更长，而其他患者特征与这种延迟无关。
除了仔细的身体（包括完整的神经系统）检查外，我们建议进行额外的神经影像学检查，特别是在每个不典型表现的厌食症病例中，以避免可能的恶性肿瘤的诊断延迟。此外，当精神障碍对治疗无反应时，有必要进行重新检查，以免忽略潜在的肿瘤疾病。
