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.

Brain tumour, Childhood cancer, Delay, Psychiatric disorder
dx.doi.org/10.1007/s00787-012-0349-7, hdl.handle.net/1765/61364
European Child and Adolescent Psychiatry
Department of Pediatrics

Hensgens, T.B, Bloemer, J, Schouten-van Meeteren, A.Y.N, Zwaan, C.M, van den Bos, C, Huyser, J, & Kaspers, G.J.L. (2013). Psychiatric symptoms causing delay in diagnosing childhood cancer: Two case reports and literature review. European Child and Adolescent Psychiatry (Vol. 22, pp. 443–450). doi:10.1007/s00787-012-0349-7