Psychiatric symptoms causing delay in diagnosing childhood cancer: two case reports and literature review

• Published in: European child & adolescent psychiatry Vol. 22; no. 7; pp. 443 - 450
• Main Authors: Hensgens, T. B., Bloemer, E., Schouten-van Meeteren, A. Y. N., Zwaan, C. M., Van den Bos, C., Huyser, C., Kaspers, G. J. L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2013; Springer Nature B.V
• Subjects: Adolescent; Anorexia nervosa; Anorexia Nervosa - complications; Anorexia Nervosa - diagnosis; Brief Report; Child; Child and Adolescent Psychiatry; Child, Preschool; Children; Delayed Diagnosis; Diagnosis; Diagnosis, Differential; Female; Humans; Literature reviews; Male; Medicine; Medicine & Public Health; Neoplasms - complications; Neoplasms - diagnosis; Psychiatric disorders; Psychiatric symptoms; Psychiatry; Tumours; Brain tumour; Delay; Childhood cancer; Psychiatric disorder
• ISSN: 1018-8827; 1435-165X
• DOI: 10.1007/s00787-012-0349-7

Introduction 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. Results 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. Discussion 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.