Abstract Introduction Neuroblastoma is the second most common childhood malignancy. Only a minority of children with metastatic disease present initially to orthopedic surgeons, despite musculoskeletal complaints such as back pain, limb pain, limp, extremity swelling, or findings mimicking osteomyelitis. These vague and nonspecific presentations increase the risk of delayed diagnosis. Aims To study orthopedic manifestations that present as the initial presenting symptoms of neuroblastoma in children and to characterize their clinical, radiological, and laboratory profiles. Materials and methods Forty-six consecutive patients with neuroblastoma were retrospectively evaluated. Medical records were reviewed, with particular attention given to the presence of orthopedic manifestations preceding the diagnosis of neuroblastoma. The children who were presented primarily to the orthopedics department were identified. The details of musculoskeletal symptoms and radiological and laboratory investigations were analyzed. Results Seven children (20%) presented initially with orthopedic complaints. Three patients had spinal involvement, including paraplegia from hydromyelia or vertebral metastasis with lytic–sclerotic lesions. Three children presented with persistent hip pain and limp and were initially diagnosed with osteomyelitis before biopsy confirmed neuroblastoma. One child presented with nontraumatic forearm swelling, initially presumed as osteomyelitis, with radiographs showing lysis of the ulnar metaphysis. A biopsy was used to establish the diagnosis. Six children had severe anemia with elevated ESR and CRP, and three had markedly elevated LDH levels. Conclusion Approximately one-fifth of children with neuroblastoma initially present to orthopedic surgeons. Persistent or atypical musculoskeletal complaints—especially hip pain or back pain accompanied by anemia, high ESR, or high CRP—should prompt the consideration of neuroblastoma and early histopathological evaluation to avoid diagnostic delays.
Kamath et al. (Thu,) studied this question.