{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T08:36:53Z","timestamp":1762072613906,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T00:00:00Z","timestamp":1666051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Neuroblastoma (NB) is the most common form of paediatric malignancy, responsible for up to 15% of cancer deaths in children, whereas in adults, its onset is a rarer event, despite being characterized by greater lethality. The purpose of this case report was to describe the clinical presentation, physical examination, and clinical decision-making process in a patient with Neuroblastoma mimicking thoracic spine pain of musculoskeletal origin. Methods: a thirty-two-year-old mother complained of thoracic spine pain on her left vertebral side and in her left periscapular muscles; her pain was constant, deep, and worse at night; she also experienced pain during physical exertion of her upper limbs; the patient also reported pain in her left breast. Results: the physiotherapist\u2019s anamnesis and physical examination led him to suspect the need for an extra-expertise pathology and to refer his patient to another medical specialist; the subsequent investigations revealed a poorly differentiated Neuroblastoma ALK + (IIC) in the posterior mediastinum on the left; the patient underwent surgery excision after 4 months. Conclusions: differential screening should be a physiotherapist\u2019s fundamental skill in their patients\u2019 clinical management, especially in direct access cases; the physiotherapist has an ethical and moral duty to conduct differential screening, in order to rule out extra-expertise pathologies\u2014both when patients self-refer for rehabilitation assessment, and when they are referred by other practitioners.<\/jats:p>","DOI":"10.3390\/ijerph192013448","type":"journal-article","created":{"date-parts":[[2022,10,18]],"date-time":"2022-10-18T21:18:02Z","timestamp":1666127882000},"page":"13448","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Tumour Hidden behind Thoracic Spine Pain: A Rare Case of Neuroblastoma in a Young Mother\u2014A Case Report"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5910-6238","authenticated-orcid":false,"given":"Valerio","family":"Passudetti","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences and Translational Medicine, Medicine and Surgery School, University of Roma \u201cTor Vergata\u201d, 00133 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2963-7550","authenticated-orcid":false,"given":"Luca","family":"De Leo","sequence":"additional","affiliation":[{"name":"Check-Up Center Private Practice, 73020 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9683-9975","authenticated-orcid":false,"given":"Filippo","family":"Maselli","sequence":"additional","affiliation":[{"name":"Department of Human Neurosciences, University of Roma \u201cSapienza\u201d, 00185 Rome, Italy"},{"name":"Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5874-0376","authenticated-orcid":false,"given":"Raffaello","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Antalgic Mini-Invasive and Rehab-Outpatients Unit, Department of Medicine and Science of Aging, University \u201cG. d\u2019Annunzio\u201d Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8950-8203","authenticated-orcid":false,"given":"Fabrizio","family":"Brindisino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Science \u201cVincenzo Tiberio\u201d, University of Molise C\/da Tappino c\/o Cardarelli Hospital, 86100 Campobasso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1080\/14737140.2017.1285230","article-title":"Overview and recent advances in the treatment of neuroblastoma","volume":"17","author":"Whittle","year":"2017","journal-title":"Expert Rev. Anticancer Ther."},{"key":"ref_2","first-page":"284","article-title":"Nervous system: Embryonal tumors: Neuroblastoma","volume":"24","author":"Pudela","year":"2020","journal-title":"Atlas Genet. Cytogenet. Oncol. Haematol."},{"unstructured":"Howlader, N., Noone, A.M., Krapcho, M., Neyman, N., Aminou, R., Waldron, W., Altekruse, S.F., Kosary, C.L., Ruhl, J., and Tatalovich, Z. (2022, October 10). SEER Cancer Statistics Review, 1975\u20132009 (Vintage 2009 Populations). National Cancer Institute. Available online: https:\/\/seer.cancer.gov\/archive\/csr\/1975_2009_pops09\/.","key":"ref_3"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.canlet.2004.12.054","article-title":"The role of age in neuroblastoma risk stratification: The German, Italian, and children\u2019s oncology group perspectives","volume":"228","author":"London","year":"2005","journal-title":"Cancer Lett."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/2162-3619-3-20","article-title":"Neuroblastoma of the elderly, an oncologist\u2019s nightmare: Case presentation, literature review and SEER database analysis","volume":"3","author":"Rogowitz","year":"2014","journal-title":"Exp. Hematol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/MPH.0000000000000144","article-title":"Neuroblastoma in the adult: The Italian experience with 21 patients","volume":"36","author":"Sorrentino","year":"2014","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3169","DOI":"10.1200\/JCO.2014.56.1621","article-title":"Clinical, biologic, and prognostic differences on the basis of primary tumor site in neuroblastoma: A report from the international neuroblastoma risk group project","volume":"32","author":"Vo","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1200\/JCO.2011.37.9990","article-title":"Outcome after surgery alone or with restricted use of chemotherapy for patients with low-risk neuroblastoma: Results of Children\u2019s Oncology Group study P9641","volume":"30","author":"Strother","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2028","DOI":"10.1002\/(SICI)1097-0142(19970515)79:10<2028::AID-CNCR26>3.0.CO;2-V","article-title":"Neuroblastoma in adults and adolescents. An indolent course with poor survival","volume":"79","author":"Franks","year":"1997","journal-title":"Cancer"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1002\/mpo.10273","article-title":"Neuroblastoma in adolescents and adults: The Memorial Sloan-Kettering experience","volume":"41","author":"Kushner","year":"2003","journal-title":"Med. Pediatr. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/pbc.20859","article-title":"Neuroblastoma in adults: Incidence and survival analysis based on SEER data","volume":"49","author":"Esiashvili","year":"2007","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1002\/cncr.11521","article-title":"Neuroblastoma in adolescents","volume":"98","author":"Gaspar","year":"2003","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s12094-010-0466-z","article-title":"Neuroblastoma in adolescents: Genetic and clinical characterization","volume":"12","author":"Castel","year":"2010","journal-title":"Clin. Transl. Oncol."},{"key":"ref_14","first-page":"1870","article-title":"Standard-dose and high- dose peptichemio and cisplatin in children with disseminated poor-risk neuroblastoma: Two studies by the Italian Cooperative Group for Neuroblastoma","volume":"10","author":"Carli","year":"1991","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1148\/radiol.11101352","article-title":"Guidelines for imaging and staging of neuroblastic tumors: Consensus report from the International Neuroblastoma Risk Group Project","volume":"261","author":"Brisse","year":"2011","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1200\/JCO.2008.16.6785","article-title":"The International Neuroblastoma Risk Group (INRG) classification system: An INRG Task Force report","volume":"27","author":"Cohn","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1067\/j.cpradiol.2018.08.008","article-title":"Practical Application of the International Neuroblastoma Risk Group Staging System: A Pictorial Review","volume":"48","author":"Donnelly","year":"2019","journal-title":"Curr. Probl. Diagn. Radiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1200\/JCO.2008.16.6876","article-title":"The International Neuroblastoma Risk Group (INRG) staging system: An INRG Task Force report","volume":"27","author":"Monclair","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1200\/JCO.1993.11.8.1466","article-title":"Revisions of the international criteria for neuroblastoma diagnosis, staging, and response to treatment","volume":"11","author":"Brodeur","year":"1993","journal-title":"J. Clin. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"250834","DOI":"10.1155\/2012\/250834","article-title":"Evaluation of Norepinephrine Transporter Expression and Metaiodobenzylguanidine Avidity in Neuroblastoma: A Report from the Children\u2019s Oncology Group","volume":"2012","author":"DuBois","year":"2012","journal-title":"Int. J. Mol. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1158\/1078-0432.CCR-1051-2","article-title":"A systematic review of molecular and biological tumor markers in neuroblastoma","volume":"10","author":"Riley","year":"2004","journal-title":"Clin. Cancer Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16068","DOI":"10.1038\/nrdp.2016.78","article-title":"Neuroblastoma","volume":"2","author":"Matthay","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1056\/NEJMoa1001527","article-title":"Outcome after reduced chemotherapy for intermediate-risk neuroblastoma","volume":"363","author":"Baker","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1200\/JCO.19.00919","article-title":"Maintaining Outstanding Outcomes Using Response- and Biology-Based Therapy for Intermediate-Risk Neuroblastoma: A Report From the Children\u2019s Oncology Group Study ANBL0531","volume":"37","author":"Twist","year":"2019","journal-title":"J. Clin. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1001\/jama.2019.11642","article-title":"Effect of Tandem Autologous Stem Cell Transplant vs Single Transplant on Event-Free Survival in Patients With High-Risk Neuroblastoma: A Randomized Clinical Trial","volume":"322","author":"Park","year":"2019","journal-title":"JAMA"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1093\/ptj\/pzaa034","article-title":"Blood pressure screening by outpatient physical therapists: A call to action and clinical recommendations","volume":"100","author":"Severin","year":"2020","journal-title":"Phys. Ther."},{"unstructured":"American Physical Therapy Association (2001). Guide to physical therapist practice. Phys. Ther., 81, 9\u2013746.","key":"ref_27"},{"unstructured":"Neumann, D.A. (2016). Kinesiology of the Musculoskeletal System, Foundations for Rehabilitation, Elsevier. [3rd ed.].","key":"ref_28"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1080\/09638288.2020.1804626","article-title":"The diagnostic value of Red Flags in thoracolumbar pain: A systematic review","volume":"44","author":"Maselli","year":"2022","journal-title":"Disabil. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0895-4356(98)00094-8","article-title":"The Italian SF-36 Health Survey: Translation, validation and norming","volume":"51","author":"Apolone","year":"1998","journal-title":"J. Clin. Epidemiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2519\/jospt.2006.0107","article-title":"Physical therapists as diagnosticians: Drawing the line on diagnosing pathology","volume":"36","author":"Boissonnault","year":"2006","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1093\/ptj\/72.12.875","article-title":"Clinical reasoning in manual therapy","volume":"72","author":"Jones","year":"1992","journal-title":"Phys. Ther."},{"doi-asserted-by":"crossref","unstructured":"Cataldi, F., Brindisino, F., Angilecchia, D., Andreani, A., and Giovannico, G. (2022). Neoplastic malignant cord compression mimicking low back pain: A case report. Physiother. Res. Int., e1971.","key":"ref_33","DOI":"10.1002\/pri.1971"},{"doi-asserted-by":"crossref","unstructured":"Sforza, C., Margelli, M., Mourad, F., Brindisino, F., Heick, J.D., and Maselli, F. (2022). Spontaneous spleen rupture mimicking non-specific thoracic pain: A rare case in physiotherapy practice. Physiother. Theory Pract., 1\u20139.","key":"ref_34","DOI":"10.1080\/09593985.2021.2021578"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1080\/09593985.2020.1768611","article-title":"Recognition of pulmonary pathology in a patient presenting with shoulder pain","volume":"38","author":"Brindisino","year":"2022","journal-title":"Physiother. Theory Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"686","DOI":"10.32098\/mltj.04.2020.17","article-title":"A description of Physical Therapists\u2019 Knowledge in Basic Competence Examination of Musculoskeletal Conditions: An Italian National Cross-Sectional Survey","volume":"10","author":"Giovannico","year":"2020","journal-title":"Muscles Ligaments Tendons J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"682","DOI":"10.2519\/jospt.2010.0109","article-title":"Red flags: To screen or not to screen?","volume":"40","author":"Ross","year":"2010","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1093\/oxfordjournals.aje.a114745","article-title":"The incidence and epidemiologic characteristics of neuroblastoma in the United States","volume":"126","author":"Davis","year":"1987","journal-title":"Am. J. Epidemiol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13448\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:56:16Z","timestamp":1760144176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,18]]},"references-count":38,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph192013448"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192013448","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,10,18]]}}}