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KEMİK VE EKLEM AĞRISI İLE BAŞVURAN AKUT LENFOBLASTİK LÖSEMİLİ ÇOCUK HASTALARIN KLİNİK, LABORATUVAR VE RADYOLOJİK ÖZELLİKLERİNİN DEĞERLENDİRİLMESİ

Year 2021, Volume: 28 Issue: 4, 607 - 611, 30.12.2021
https://doi.org/10.17343/sdutfd.805060

Abstract

Amaç
Akut lenfoblastik lösemi (ALL) en sık görülen çocukluk
çağı kanseridir. Çabuk yorulma, morarma, kanama,
sebebi bilinmeyen ateş gibi şikayetlerin yanı sıra;
non-spesifik kemik ve eklem ağrısı ilk başvuru bulgusu
olabilmektedir. Bu çalışmanın amacı; kemik ve
eklem ağrısı şikayeti ile başvuran hastaların demografik
özelliklerini, laboratuvar bulgularını ve tedavi sonuçlarını
belirlemek, kemik eklem ağrısı olmayan ALL
hastaları ile karşılaştırmak ve kemik-eklem ağrısı olan
hastaların radyolojik bulgularını değerlendirmektir.
Gereç ve Yöntem
Sağlık Bilimleri Üniversitesi Ankara Çocuk Sağlığı ve
Hastalıkları Çocuk Hematoloji Onkoloji Eğitim Araştırma
Hastanesi Pediatrik Hematoloji Bilim Dalında,
Ocak 2013 – Haziran 2018 tarihleri arasında ALL tanısı
alan 163 hastanın dosyası retrospektif olarak incelendi.
Kemik ve eklem yakınmaları ile başvuran 33
hasta tespit edildi. Kemik eklem yakınması olan hastalar;
Grup I ve kemik eklem yakınması olmayan hastalar;
Grup II olarak sınıflandırıldı. Tüm hastaların tanı
sırasındaki demografik özellikleri, laboratuvar bulguları
ve son durumları geriye dönük olarak incelendi.
Bulgular
Grup I ve Grup II’ de yer alan hastalar arasında yaş,
cinsiyet, immünfenotiplendirme açısından istatistiksel
olarak anlamlı fark bulunmadı (p>0,05).Grup I’de; ortanca
başvuru beyaz küre değeri düşük ve trombosit
değeri ise daha yüksek saptandı (p<0,05). Grup I’de
yer alan 7 hastanın radyolojik incelemesinde (%25)
patolojik bulgular saptandı. Direkt grafide; litik lezyonlar
(n: 2), vertebralarda fraktüre bağlı yükseklik kaybı
ve osteoporoz (n: 1), vertebralarda nodüler lezyon
(n:2), fokal radyolüsen görünüm (n:2) tespit edildi.
Sonuç
Akut lenfoblastik lösemili hastalarda; kemik- eklem
ağrısı önemli bir başlangıç bulgusu olabilir. Bu has-
talarda; görüntüleme teknikleri ile saptanan patolojik
değişikliklerin hematolojik malignitelere işaret edebileceği
unutulmamalıdır.

References

  • 1. Boccuzzi E, Ferro VA, Cinicola B, Schingo PM, Strocchio L, Raucci U. Uncommon Presentation of Childhood Leukemia in Emergency Department: The Usefulness of an Early Multidisciplinary Approach. Pediatr Emerg Care. 2018 Nov 19.
  • 2. Apak A, Celkan T, Yıldız I, Zeybek C. Akut lenfoblastik lösemide iyi prognoz göstergesi; kemik tutulumu. Cocuk Sagligi Hast Derg. 2003; 46: 275-80.
  • 3. Tragiannidis A, Vasileiou E, Papageorgiou M, Damianidou L, Hatzipantelis E, Gombakis N, Giannopoulos A. Bone involvement at diagnosis as a predictive factor in children with acute lymphoblastic leukemia. Hippokratia. 2016;20(3):227-230.
  • 4. Sinigaglia R, Gigante C, Bisinella G, Varotto S, Zanesco L, Turra S. Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 2008;28(1):20-8.
  • 5.Heinrich SD, Gallagher D, Warrior R, Phelan K, George VT, MacEwen GD. The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood. J Pediatr Orthop. 1994;14(1):105‐111.
  • 6. Tafaghodi F, Aghighi Y, Rokni Yazdi H, Shakiba M, Adibi A. Predictive plain X-ray findings in distinguishing early stage acute lymphoblastic leukemia from juvenile idiopathic arthritis. Clin Rheumatol. 2009;28(11):1253-8.
  • 7. Balan S. Approach to Joint Pain in Children. Indian J Pediatr. 2016;83(2):135-9. doi: 10.1007/s12098-015-2016-8. Epub 2016 Jan 9.
  • 8. Louvigné M, Rakotonjanahary J, Goumy L, Tavenard A, Brasme JF, Rialland F, Baruchel A, Auclerc MF, Despert V, Desgranges M, Jean S, Faye A, Meinzer U, Lorrot M, Job-Deslandre C, Bader-Meunier B, Gandemer V, Pellier I; GOCE Group. Persistent osteoarticular pain in children: early clinical and laboratory findings suggestive of acute lymphoblastic leukemia (a multicenter case-control study of 147 patients). Pediatr Rheumatol Online J. 2020, 2;18(1):1.
  • 9. Latha MS, Thirugnanasambandam RP, Venkatraman P, Scott JX. Back pain: An unusual manifestation of acute lymphoblastic leukemia - A case report and review of literature. J Family Med Prim Care. 2017;6(3):657-659.
  • 10. Müller HL, Horwitz AE, Kühl J. Acute lymphoblastic leukemia with severe skeletal involvement: a subset of childhood leukemia with a good prognosis. Pediatr Hematol Oncol. 1998;15(2):121-33.
  • 11. 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(2 Pt 1):233-7.
  • 12. Gallagher DJ, Phillips DJ, Heinrich SD. Orthopedic manifestations of acute pediatric leukemia. Orthop Clin North Am. 1996;27(3):635-44.
  • 13. Kubota H, Saida S, Kouzuki K, Hamabata T, Daifu T, Kato I, Umeda K, Hiramatsu H, Nishikomori R, Heike T, Okamoto T, Adachi S. (Pediatric acute lymphoblastic leukemia presenting with bone and joint pain). Rinsho Ketsueki. 2018;59(2):167-173. Japanese. doi: 10.11406/rinketsu.59.167. (Abstract)
  • 14. Kato M, Koh K, Kikuchi A, Toyama D, Mochizuki S, Uchisaka N, Nagatoshi Y, Tanaka R, Oh-Ishi T, Nozawa K, Oguma E, Hanada R. Case series of pediatric acute leukemia without a peripheral blood abnormality, detected by magnetic resonance imaging. Int J Hematol. 2011;93(6):787-790.

EVALUATION OF CLINICAL, LABORATORY AND RADIOLOGICAL FEATURES OF PEDIATRIC ACUTE LYMPHOBLASTIC LEUKEMIA PATIENTS PRESENTING WITH BONE AND JOINT PAIN

Year 2021, Volume: 28 Issue: 4, 607 - 611, 30.12.2021
https://doi.org/10.17343/sdutfd.805060

Abstract

Objective
Acute lymphoblastic leukemia (ALL) is the most
common childhood cancer. In addition to complaints
such as fatigue, bruising, bleeding, fever of unknown
origin, non-specific bone, and joint pain may be the
first sign. The purpose of this study, to determine the
demographic characteristics, laboratory findings, and
treatment results of patients presenting with bone and
joint pain and to compare with ALL patients without
bone joint pain, and to evaluate the radiological
findings of patients with bone joint pain.
Material and Methods
Data of 163 patients who were diagnosed, treated
and followed up with the diagnosis of ALL in the
University of Health Sciences, Ankara City Hospital,
Department of Pediatric Hematology and Oncology
between January 2013 and June 2018 were evaluated
retrospectively. A total of 33 patients presented with
bone and joint complaints. The demographic features,
laboratory findings, and recent status of all patients
were examined retrospectively.
Results
There was no statistically significant difference
between the patients with bone and joint complaints
(Group I) and without bone and joint complaints (Group
II) in terms of age, gender, and immunophenotyping
(p> 0.05). The median white blood cell was lower, and
the platelet value was higher in Group I at diagnosis (p
<0.05). Positive findings were detected in seven (25%)
patients with direct radiography. On radiographs;
lytic lesions (n: 2), fracture-related height loss and
osteoporosis (n: 1) in the vertebrae, nodular lesions
(n:2) in the vertebrae, focal radiolucent appearance
(n:2) were detected.
Conclusion
Bone-joint pain may be a critical presenting sign in
patients with ALL, and pathological changes detected
by imaging techniques may indicate hematological
malignancies.

References

  • 1. Boccuzzi E, Ferro VA, Cinicola B, Schingo PM, Strocchio L, Raucci U. Uncommon Presentation of Childhood Leukemia in Emergency Department: The Usefulness of an Early Multidisciplinary Approach. Pediatr Emerg Care. 2018 Nov 19.
  • 2. Apak A, Celkan T, Yıldız I, Zeybek C. Akut lenfoblastik lösemide iyi prognoz göstergesi; kemik tutulumu. Cocuk Sagligi Hast Derg. 2003; 46: 275-80.
  • 3. Tragiannidis A, Vasileiou E, Papageorgiou M, Damianidou L, Hatzipantelis E, Gombakis N, Giannopoulos A. Bone involvement at diagnosis as a predictive factor in children with acute lymphoblastic leukemia. Hippokratia. 2016;20(3):227-230.
  • 4. Sinigaglia R, Gigante C, Bisinella G, Varotto S, Zanesco L, Turra S. Musculoskeletal manifestations in pediatric acute leukemia. J Pediatr Orthop. 2008;28(1):20-8.
  • 5.Heinrich SD, Gallagher D, Warrior R, Phelan K, George VT, MacEwen GD. The prognostic significance of the skeletal manifestations of acute lymphoblastic leukemia of childhood. J Pediatr Orthop. 1994;14(1):105‐111.
  • 6. Tafaghodi F, Aghighi Y, Rokni Yazdi H, Shakiba M, Adibi A. Predictive plain X-ray findings in distinguishing early stage acute lymphoblastic leukemia from juvenile idiopathic arthritis. Clin Rheumatol. 2009;28(11):1253-8.
  • 7. Balan S. Approach to Joint Pain in Children. Indian J Pediatr. 2016;83(2):135-9. doi: 10.1007/s12098-015-2016-8. Epub 2016 Jan 9.
  • 8. Louvigné M, Rakotonjanahary J, Goumy L, Tavenard A, Brasme JF, Rialland F, Baruchel A, Auclerc MF, Despert V, Desgranges M, Jean S, Faye A, Meinzer U, Lorrot M, Job-Deslandre C, Bader-Meunier B, Gandemer V, Pellier I; GOCE Group. Persistent osteoarticular pain in children: early clinical and laboratory findings suggestive of acute lymphoblastic leukemia (a multicenter case-control study of 147 patients). Pediatr Rheumatol Online J. 2020, 2;18(1):1.
  • 9. Latha MS, Thirugnanasambandam RP, Venkatraman P, Scott JX. Back pain: An unusual manifestation of acute lymphoblastic leukemia - A case report and review of literature. J Family Med Prim Care. 2017;6(3):657-659.
  • 10. Müller HL, Horwitz AE, Kühl J. Acute lymphoblastic leukemia with severe skeletal involvement: a subset of childhood leukemia with a good prognosis. Pediatr Hematol Oncol. 1998;15(2):121-33.
  • 11. 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(2 Pt 1):233-7.
  • 12. Gallagher DJ, Phillips DJ, Heinrich SD. Orthopedic manifestations of acute pediatric leukemia. Orthop Clin North Am. 1996;27(3):635-44.
  • 13. Kubota H, Saida S, Kouzuki K, Hamabata T, Daifu T, Kato I, Umeda K, Hiramatsu H, Nishikomori R, Heike T, Okamoto T, Adachi S. (Pediatric acute lymphoblastic leukemia presenting with bone and joint pain). Rinsho Ketsueki. 2018;59(2):167-173. Japanese. doi: 10.11406/rinketsu.59.167. (Abstract)
  • 14. Kato M, Koh K, Kikuchi A, Toyama D, Mochizuki S, Uchisaka N, Nagatoshi Y, Tanaka R, Oh-Ishi T, Nozawa K, Oguma E, Hanada R. Case series of pediatric acute leukemia without a peripheral blood abnormality, detected by magnetic resonance imaging. Int J Hematol. 2011;93(6):787-790.
There are 14 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Zeliha Guzelkucuk 0000-0003-1462-6867

Eymen Yılmaz 0000-0002-4235-0581

Melek Isik 0000-0002-7503-303X

Mesut Sivri 0000-0002-1278-3386

Hüsniye Neşe Yaralı 0000-0001-5488-2385

Publication Date December 30, 2021
Submission Date February 1, 2021
Acceptance Date September 29, 2021
Published in Issue Year 2021 Volume: 28 Issue: 4

Cite

Vancouver Guzelkucuk Z, Yılmaz E, Isik M, Sivri M, Yaralı HN. KEMİK VE EKLEM AĞRISI İLE BAŞVURAN AKUT LENFOBLASTİK LÖSEMİLİ ÇOCUK HASTALARIN KLİNİK, LABORATUVAR VE RADYOLOJİK ÖZELLİKLERİNİN DEĞERLENDİRİLMESİ. Med J SDU. 2021;28(4):607-11.

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