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

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Abstract

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.

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Acknowledgments

We thank Mrs. M. Doulaki and Mrs. A. Heus for their secretarial assistance and Mrs. A. de Vries, pediatric psychiatrist VUmc for general advice.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Pediatric Oncology/Hematology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands

    T. B. Hensgens, E. Bloemer & G. J. L. Kaspers

  2. Emma Children’s Hospital AMC, Amsterdam, The Netherlands

    A. Y. N. Schouten-van Meeteren & C. Van den Bos

  3. Sophia Children’s Hospital, Rotterdam, The Netherlands

    C. M. Zwaan

  4. Academic Centre for Child and Adolescent Psychiatry De Bascule, Amsterdam, The Netherlands

    C. Huyser

Authors
  1. T. B. Hensgens
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  2. E. Bloemer
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  3. A. Y. N. Schouten-van Meeteren
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  4. C. M. Zwaan
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  5. C. Van den Bos
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  6. C. Huyser
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  7. G. J. L. Kaspers
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Corresponding authors

Correspondence to T. B. Hensgens or G. J. L. Kaspers.

Additional information

T. B. Hensgens and E. Bloemer contributed equally and share first authorship.

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Hensgens, T.B., Bloemer, E., Schouten-van Meeteren, A.Y.N. et al. Psychiatric symptoms causing delay in diagnosing childhood cancer: two case reports and literature review. Eur Child Adolesc Psychiatry 22, 443–450 (2013). https://doi.org/10.1007/s00787-012-0349-7

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  • DOI: https://doi.org/10.1007/s00787-012-0349-7

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