Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Malignancies in children who present with bone pain

뼈의 통증이 있을 때 감별해야 할 악성종양

  • Lee, Jun Ah (Department of Pediatrics, Korea Cancer Center Hospital)
  • 이준아 (원자력의학원 소아청소년과)
  • Received : 2008.06.30
  • Accepted : 2008.07.11
  • Published : 2008.08.15
Download PDF
⟨ Previous Next ⟩

Abstract

Bone pain in a child could be associated with cancer as an initial manifestation of the disease. The childhood malignancies that frequently present bone pain are leukemia, neuroblastoma, and primary bone tumors such as osteosarcoma and Ewing sarcoma. Persistent bone or joint pain associated with swelling, mass, or limitation of motion implies underlying serious causes. Systemic manifestations such as lymphadenopathy, hepatosplenomegaly, fever, fatigue, night sweat, and laboratory abnormalities are also suggestive of malignancy. The index of suspicion tends to be low since less than 1% of children who complain of bone pain are diagnosed as cancer. Nonetheless, pediatricians should be alert to the possibilities of cancer since early detection and prompt treatment might reduce mortality.

소아청소년기에 뼈의 통증은 일차진료에서 흔히 접할 수 있는 문제이다. 대부분은 성장통이나 스포츠 활동과 관련된 물리적인 원인에 의한 것이지만 급성 림프구성 백혈병, 신경모세포종, 원발성 골종양 등의 악성종양이 뼈의 통증으로 발현하는 경우도 있다. 뼈의 통증을 호소하는 소아청소년 중 악성종양으로 진단 받는 환자는 1% 미만으로 그 빈도가 매우 낮지만 진단과 적절한 치료가 지체되면 환아의 예후에 악영향을 미칠 수 있으므로 어떠한 경우에 악성종양을 의심해야 하는지 숙지해야 한다. 환아가 잠을 잘 수 없을 정도로 심한 뼈의 통증을 2주 이상 호소하며, 발열, 피로감, 야간발한 등의 전신증상이 동반되거나 림프절 비대, 간비장 비대, 사지 혹은 배가 부어 보이고 덩어리가 만져지면 CBC with differential count, 말초혈액 바른검사, CRP, ESR, 단순 방사선 촬영을 시행해야 한다. 위의 검사결과 이상소견이 발견되면 즉시 소아청소년 혈액종양 전문의에게 의뢰를 해야 할 것이다.

Keywords

References

  1. Goodman JE, McGrath PJ. The epidemiology of pain in children and adolescents: A review Pain 1991;46:247-64 https://doi.org/10.1016/0304-3959(91)90108-A
  2. de Inocencio I. Musculoskeletal pain in primary pediatric care: Analysis of 1000 consecutive general pediatric clinic visits. Pediatrics 1998;102:E63 https://doi.org/10.1542/peds.102.6.e63
  3. Trapani S, Grisolia F, Simonini G, Calabri GB, Falcini F. Incidence of occult cancer in children presenting with musculoskeletal symptoms: A lO-year survey in a pediatric rheumatology unit. Semin Arthritis Rheum 2000;29:348-59
  4. Goncalves M, Terreri MT, Barbosa CM, Len CA, Lee L, Hilario MO. Diagnosis of malignancies in children with musculoskeletal complaints. Sao Paulo Med J 2005;123:21-3
  5. Tse SM, Laxer RM. Approach to acute limb pain in childhood. Pediatr Rev. 2006;27:170-9; quiz 180 https://doi.org/10.1542/pir.27-5-170
  6. junnila JL, Cartwright VW. Chronic musculoskeletal pain in children: Part I. initial evaluation. Am Fam Physician 2006; 74:115-22
  7. Young G, Toretsky JA, Campbell AB, Eskenazi AE. Recognition of common childhood malignancies. Am Fam Physician 2000;61:2144-54
  8. Cabral DA, Tucker LB. Malignancies in children who initially present with rheumatic complaints. J Pediatr 1999;134: 53-7 https://doi.org/10.1016/S0022-3476(99)70372-0
  9. Trueworthy RC, Templeton KJ. Malignant bone tumors presenting as musculoskeletal pain. Pediatr Ann 2002;31: 355-9 https://doi.org/10.3928/0090-4481-20020601-07
  10. Westhovens R, Dequeker J. Musculoskeletal manifestations of benign and malignant tumors of bone. Curr Opin Rheumatol 2003;15:70-5 https://doi.org/10.1097/00002281-200301000-00012
  11. Annual Report of the Korea Central Cancer Registry, Ministry of Health and Welfare, Republic of Korea, 2003
  12. Jonsson OG, Sartain P, Ducore JM, Buchanan GR. Bone pain as an initial symptom of childhood acute lymphoblastic leukemia: Association with nearly normal hematologic indexes. J Pediatr 1990;117:233-7 https://doi.org/10.1016/S0022-3476(05)80535-9
  13. Lucas DR, Bentley G, Dan ME, Tabaczka P, Poulik JM, Mott MP. Ewing sarcoma vs lymphoblastic lymphoma. A comparative immunohistochemical study. Am J Clin Pathol 2001;115:11-7 https://doi.org/10.1309/K1XJ-6CXR-BQQU-V255
  14. Sinigaglia R, Gigante C, Bisinella G,Varotto S, Zanesco L, Turra S. Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop 2008;28:20-8 https://doi.org/10.1097/BPO.0b13e31815ff350
  15. Jones OY, Spencer CH, Bowyer SL, Dent PB, Gottlieb BS, Rabinovich CE. A multicenter case-control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis. Pediatrics 2006;117:e840-4 https://doi.org/10.1542/peds.2005-1515
  16. Wallendal M, Stork L, Hollister JR. The discriminating value of serum lactate dehydrogenase levels in children with malignant neoplasms presenting as joint pain. Arch Pediatr Adolesc.Med. 1996;150:70-3 https://doi.org/10.1001/archpedi.1996.02170260074012
  17. Ostrov BE, Goldsmith DP, Athreya BH. Differentiation of systemic juvenile rheumatoid arthritis from acute leukemia near the onset of disease. J Pediatr 1993;122:595-8 https://doi.org/10.1016/S0022-3476(05)83543-7
  18. Deane PM, Liard G, Siegel DM, Baum J. The outcome of children referred to a pediatric rheumatology clinic with a positive antinuclear antibody test but without an autoimmune disease. Pediatrics 1995;95:892-5
  19. Kim EK, Kang HJ, Park JA, Choi HS, Shin HY, Ahn HS. Retrospective analysis of peripheral blood stem cell transplantation for the treatment of high-risk neuroblastoma. J Korean Med Sci 2007;22 Suppl:S66-72 https://doi.org/10.3346/jkms.2007.22.S.S66
  20. Park JR, Eggert A, Caron H. Neuroblastoma: Biology, prognosis, and treatment. Pediatr Clin North Am 2008;55:97-120 https://doi.org/10.1016/j.pcl.2007.10.014
  21. Buckley JD, Pendergrass TW, Buckley CM, Pritchard DI, Nesbit ME, Provisor AJ, et al. Epidemiology of osteosarcoma and ewing's sarcoma in childhood: A study of 305 cases by the children's cancer group. Cancer 1998;83:1440-8 https://doi.org/10.1002/(SICI)1097-0142(19981001)83:7<1440::AID-CNCR23>3.0.CO;2-3
  22. Burke MJ, Walterhouse DO, Jacobsohn DA, Duerst RE, Kletzel M. Tandem high-dose chemotherapy with autologous peripheral hematopoietic progenitor cell rescue as consolidation therapy for patients with high-risk ewing family tumors. Pediatr Blood Cancer 2007;49:196-8 https://doi.org/10.1002/pbc.21182