Background: Non Hodgkin lymphoma (NHL) is the fourth most common malignancy in childhood. Chemotherapy constitutes the first line treatment and may cause several endocrine side effects (growth retardation, hypergonadotrophic hypogonadism, bone mass loss and rarely secondary malignancy). In total of 12% of children may harbour thyroid nodules. The most common risk factors are: irradiation, female sex, iodine deficiency, puberty and past medical history of thyroid disease. In children with nodules, thyroids malignancy incidence is higher than in adults (26.4% against 10% respectively).
Objective and hypotheses: Report the case of an 11-year-old girl with thyroid malignancy after chemotherapy for NHL.
Patients and Method: A 7-year-old girl was diagnosed with NHL and underwent chemotherapy until the age of 9years (BFM95 protocol: intensive phase of 6 months with vincristine, cyclophosphamide, aracytin, asparaginase and maintenance phase of 18 months with mercaptopurine and methotrexate). Her 6 months endocrine laboratory and imaging follow-up was normal. At 11 years thyroid ultrasound revealed a sonic mass sizing 1.23×1.0×0.68 cm with blurred limits and heterogeneous consistency, presenting calcifications and moderate vascularity. A fine needle aspiration biopsy (FNA) revealed a papillary neoplasm. Total thyroidectomy followed and histopathology confirmed the diagnosis of a multi focused, diffused papillary carcinoma.
Conclusion: While irradiation is a known risk factor of thyroid malignancy, increased thyroids neoplasm incidence has not been described after chemotherapy. It is known that developing a second malignancy is more frequent in children first diagnosed at a younger age. Younger patients may have a genetic predisposition. Additionally, environmental and epigenetic interactions may contribute to the appearance of both primary and secondary malignancy. Our case emerges the necessity of systematic follow up of the thyroid gland (detailed medical history, physical examination and laboratory exams) for children that underwent chemotherapy. FNA represents the gold standard for diagnosing a thyroid nodule identified through palpation or ultrasound.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology