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Papillary thyroid carcinoma after total body irradiation
C Uderzo1, M T van Lint, A Rovelli
1Department of Paediatric Haematology and Oncology, S Gerardo Hospital, University of Milan, Monza, Italy.
Archives of Disease in Childhood
|September 1, 1994
Summary
Papillary thyroid carcinoma can occur after bone marrow transplantation (BMT), likely due to radiation therapy. Regular thyroid monitoring with ultrasound and biopsies is recommended for BMT patients.
Area of Science:
- Oncology
- Endocrinology
- Hematology
Background:
- Allogeneic bone marrow transplantation (BMT) involves conditioning regimens that may include radiotherapy.
- Radiotherapy and certain conditioning agents are known risk factors for secondary malignancies.
- Thyroid function and potential long-term effects require careful consideration post-BMT.
Observation:
- Two pediatric cases of papillary thyroid carcinoma (PTC) were identified following allogeneic BMT.
- The development of PTC occurred after radiotherapy administered during remission and as part of pretransplantation conditioning.
- Elevated serum thyroid stimulating hormone (TSH) concentrations were noted, but a direct cellular link to carcinoma development was challenging to establish.
Findings:
- A probable association exists between radiotherapy during BMT and the subsequent development of papillary thyroid carcinoma.
- The study highlights the difficulty in directly correlating cellular TSH effects with carcinoma in patients with high TSH levels.
- The findings underscore the importance of vigilant post-transplant surveillance for thyroid abnormalities.
Implications:
- Patients undergoing allogeneic BMT require long-term, regular thyroid surveillance.
- Thyroid ultrasound is a recommended screening tool for detecting thyroid abnormalities post-BMT.
- Nodularity detected on ultrasound warrants further investigation, including fine needle aspiration and/or open biopsy, to rule out malignancy.