The Discriminating Value of Serum LactateDehydrogenase Levels in Children With Malignant Neoplasms Presenting as Joint Pain

Wallendal, Michele; Stork, Linda C.; Hollister, J. Roger

doi:10.1001/archpedi.1996.02170260074012

Cited by 40 publications

(20 citation statements)

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“…Raised lactate dehydrogenase level has been recognized as a marker of cell turnover and has been reported to be an important test for the screening of children with a suspicion of neoplasia who initially present with musculoskeletal complaints. 17 Wallendal et al 17 studied 12 patients with a final diagnosis of neoplasia whose initial manifestations were arthritis or arthralgia, and reported that all had an initial increase in the lactate dehydrogenase level. Most of our patients also presented increased lactate dehydrogenase level .…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of malignancies in children with musculoskeletal complaints

et al. 2005

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CONTEXT: Musculoskeletal complaints may be associated with neoplasias as an initial manifestation of the disease. When these symptoms predominate at the onset of the disease, the differential diagnosis includes several rheumatic diseases. OBJECTIVE: To assess the frequency, clinical features and types of cancer manifested in children presenting with musculoskeletal complaints over a seven-year period. TYPE OF STUDY: Retrospective. SETTING: Discipline of Allergy, Clinical Immunology and Rheumatology, Universidade Federal de São Paulo - Escola Paulista de Medicina. METHODS: The medical records of patients with musculoskeletal complaints and final diagnosis of malignant disease were reviewed. The data collected were: age when symptoms initially presented, age at diagnosis, clinical features presented, laboratory findings, and the initial and final diagnoses. RESULTS: A final diagnosis of cancer was found in nine out of 3,528 patients (0.25%) whose initial symptom was musculoskeletal pain. The mean time between disease onset and final diagnosis was five months. The most common features presented were pauciarticular arthritis or arthralgia involving the large joints. Juvenile rheumatoid arthritis was the most frequent initial diagnosis, in four out of nine patients. Anemia was the most frequent initial hematological change. Six out of eight patients had an increased erythrocyte sedimentation rate. The lactate dehydrogenase level was raised in five out of eight patients. The malignancies found included acute lymphocytic leukemia, acute myeloid leukemia, lymphoma, neuroblastoma and Ewing's sarcoma. DISCUSSION: The frequency of neoplasia in patients with musculoskeletal pain resembled reports in the literature. Consumptive symptoms were not the warning signal in most of our patients. In subsidiary tests, progressive anemia was the most common finding, although the peripheral blood cell count may continue to be normal for weeks or months after symptom onset. CONCLUSION: Malignancy always needs to be ruled out in cases of children with musculoskeletal complaints. Uncharacteristic clinical manifestations and nonspecific laboratory tests may cause difficulty in the final diagnosis, and rigorous investigation should be performed.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of malignancies in children with musculoskeletal complaints

et al. 2005

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“…Although abnormalities are non-specific, if all parameters are completely normal, the probability of a bone or joint infection, malignancy or inflammatory condition is reduced but not zero [43, 51,53]. The potential value of lactate dehydrogenase (LDH) in distinguishing malignancy from JIA has been reported [65]. The retrospective study compared 12 patients with neoplasia presenting with MSK symptoms, normal blood count and film to 24 patients with a final diagnosis of JIA (20 sJIA, three polyarticular JIA and one oligoarticular JIA).…”

Section: What Laboratory Investigations Assist In Diagnosis Classifimentioning

confidence: 99%

The child with joint pain in primary care

Sen

Clarke

Ramanan

2014

Best Practice & Research Clinical Rheumatology

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“…Serum lactate dehydrogenase is known to be a useful marker of cell turnover and is often raised in malignancy. Wallendal et al showed that although normal lactate dehydrogenase concentrations do not exclude malignancy, the presence of arthritis with raised lactate dehydrogenase and otherwise normal laboratory results is a cause for concern 9. Cabral et al, however, found that lactate dehydrogenase concentrations were raised in only 24% of patients who were subsequently diagnosed with acute lymphoblastic leukaemia,6 and Ostrov et al found no significant difference 5.…”

Section: Discussionmentioning

confidence: 99%