Neoplastic Limp or Irritable Hip?

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Irritable hip is the most common cause of hip pain in children and the clinical priority for clinicians is the timely identification and management of septic arthritis. However other rare conditions such as malignancy must be considered as the differential diagnosis. Neuroblastoma accounts for 7- 10% of childhood malignancies and is one of the most common extracranial solid tumours occurring in paediatric population. It arises from sympathetic neural tissue, and therefore can occur anywhere within the sympathetic nervous system. It most frequently originates within the abdominal cavity (65%) or follows the distribution of the sympathetic ganglia along paraspinal areas from the neck to the pelvis. The majority (80%) of cases present in children younger than 5 years.

 

It has been well recognized that neuroblastoma conveys a widely varying clinical picture which is inherently a major cause of delayed recognition. The most common clinical presentation of this malignant neoplasm is abdominal mass. Nevertheless, 15% of cases present with hip pain or limping. A child who has an acutely irritable hip with septic picture can pose a diagnostic challenge. Although neuroblastomas are rare in children, symptoms may substantially overlap in the acute setting makes differentiation difficult and can therefore be easily missed by the admitting doctor.

 

In this case report, we have outlined the importance of neurological examination, radiological investigation and haematological factors in two cases presented with extra- abdominal neuroblastoma and the pitfalls in making the correct diagnosis. The main purpose of this pictorial report is to increase awareness of orthopaedic surgeons of the possible presentation of this uncommon childhood malignancy and deliver early prompt diagnosis by which can influence the prognosis favorably.

The Journal of Orthopedic Oncology offers information in all aspects of primary, malignant tumors. Osteosarcoma, Ewing's sarcoma, chondrosarcoma, chordoma, and soft tissue sarcomas etc., it also deals with diagnostic methods, therapeutic approaches, clinical, laboratory research and reconstructive techniques.

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Best Regards,

Stella

Editorial Team

Journal of Orthopedic Oncology

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