Gastrointestinal Symptoms As The Initial Manifestation Of Brain Tumors: Analysis Clinical Feature Of 153 Patients

The most common solid tumors in childhood are intracranial tumors,the incidence is at the second place in all tumors^[1].Different from adults,the presentation of childhood brain tumor are non-specific,and symptoms such as vomiting,headache,seizures,and change consciousness are often present^[2].Most of children have gastrointestinal symptoms as the initial presenting symptoms,including vomiting,abdominal pain,diarrhea,and poor appetite.In clinical practice,pediatric brain tumors with gastrointestinal symptoms as the initial symptoms are often misdiagnosed as gastrointestinal diseases such as gastroenteritis and gastroesophageal reflux.The intracranial tumor damages central nervous system and delayed treatments are seriously harmful for children.The prognosis of intracranial tumor is tightly relative to the tumor size,location,malignant degree and early diagnosis and treatment.Therefore,early recognition,appropriate treatment and avoiding misdiagnosis remain important in pediatric brain tumor.In this study,we analyzed intracranial tumors with gastrointestinal symptoms as the first symptom in children,mainly in terms of the age,gender,course of disease,clinical symptoms,interval before diagnosis,times of visits,pathology,imaging,complications and so on,analyzed the clinical features of pediatric brain tumors to improve the ability of clinicians to diagnosis and treatment and improve the prognosis.Objective:To analyze the clinical features,pathology,prediagnostic symptomatic interval,and misdiagnosis reason of pediatric brain tumors.Methods:A retrospective observational study was performed of 153 patients of brain tumors with gastrointestinal symptoms as the initial symptoms,in Children's Hospital of Zhejiang University School of Medicine between January 2015 and December 2019.Including age,gender,course of disease,presenting symptoms,diagnosis,time interval from onset of symptoms to definitive diagnosis,clinic department and number of health care visits prior to diagnosis,misdiagnosed disease,MRI,CT,pathology and complications.Results:?1?General date:There were 93 males and 60 females in 153 patients.The youngest patient is 2months,and the oldest patient is 14.25 years,median age at the time of diagnosis was 5.17 years.The shortest duration is 3 hours?0.04 months?and the longest duration is 17 months.?2?Clinical manifestations:The main clinical manifestation is vomiting?98.7%?and poor appetite?68.0%?,the other manifestations include Headache,ataxia,change of consciousness,seizures,fever,abnormal eye movement or vision,motor dysfunction,malnutrition,abdominal pain,growth and development lag,increased head circumference?43.1%,12.4%,11.0%,9.1%,5.9%,5.9%,4.5%,1.9%,1.3%,0.7%?.?3?Prediagnostic symptomatic interval?PSI?:The median time of PSI in all children was 10 days?range 1-510d?.There was no significant difference in median PSI among the age and gender of patients.The WHO grade III tumors were associated with a significantly shorter PSI relative to WHO grade I tumors.The median of PSI was longer in patients with infratentorial tumors than in patients with supratentorial tumors.?4?Times of visits,clinic department,misdiagnosed disease:152 patients had clear number of health care visits prior to definitive diagnosis.average visiting times is2.34 times;The first visits to internal medicine made up 83%;gastroenterology and neurology were the most common pediatric subspecialties visited prior to diagnosis.32patients were misdiagnosed as gastroenteritis,accounting for 20.9%,16 patients were misdiagnosed as other diseases,accounting for 10.5%.?5?CT or MRI shows that 69 patients had tumors located in the supratentorial area and 84 in the infratentorial area.The detection rates of MRI and CT are 100%.?6?Pathological type:The top five incidence rate of tumorsmedulloblastoma?26.8%?,Pilocytic astrocytoma?9.8%?,ependymoma?9.8%?,immature teratoma?6.6%?and atypical teratoid/rhabdomyoma?3.9%?.The tumor pathology of 120 children has a clear WHO grade,including 47 cases of tumors below WHO grade II,9 cases of WHO grade III and 64 cases of WHO grade IV.?7?There were 1 male and 5 females patients with 6 atypical teratoid/rhabdoid tumors,15 males and 3 females patients with 18 primary CNS germ cell tumor.The differences in other pathologic types between the grade groups were not statistically significant.?8?The differences in the course of disease between the different age groups?<1years,1-3years,3-7years,?14years?,and gender were not statistically significant.?9?Complications:Obstructive hydrocephalus was found in 78 cases?51%?,cerebral hernia in 5 cases and malnutrition in 6 cases.Conclusions:?1?The most frequent histological type include Medulloblastoma,pilocytic astrocytoma,ependymoma,immature teratoma and atypical teratoid/rhabdoid tumors;other common types are choroid plexus tumor,craniopharyngioma,pineal blastoma,germinoma,diffuse glioma,etc.?2?The most common symptom was vomiting,then poor appetite;the common accompanied symptoms were headache,Headache,ataxia,change of consciousness,seizures.?3?The median interval between symptom and diagnosis was 10 days?range 1-510days?.The longer time interval before diagnosis was related to location and WHO grade of tumor.There was no significant difference in symptom interval before diagnosis between different age groups and genders.?4?Children with repeated vomiting and poor appetite,If necessary,MRI,CT and other imaging examinations should be improved to exclude intracranial tumors and avoided misdiagnosis and missed diagnosis avoided.