title: Psychiatric symptoms causing delay in diagnosing childhood cancer: two case reports and literature review.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatric Oncology/Hematology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. tamara_hensgens@hotmail.com
authors.forename: T B
authors.initials: TB
authors.lastname: Hensgens
authors.forename: E
authors.initials: E
authors.lastname: Bloemer
authors.forename: A Y N
authors.initials: AY
authors.lastname: Schouten-van Meeteren
authors.forename: C M
authors.initials: CM
authors.lastname: Zwaan
authors.forename: C
authors.initials: C
authors.lastname: Van den Bos
authors.forename: C
authors.initials: C
authors.lastname: Huyser
authors.forename: G J L
authors.initials: GJ
authors.lastname: Kaspers
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis*