Session: SUN 459-496-Thyroid Neoplasia & Case Reports
Poster Board SUN-470
Clinical case: A 4 year old female with a history of NB presented to the pediatric otolaryngology clinic following an incidentally discovered right thyroid nodule on surveillance chest CT. After diagnosis of stage IV NB at 2 years of age, she received induction chemotherapy followed by autologous stem cell transplantation, external beam radiation to abdominal tumor site (total 35Gy (estimated 3cGy to thyroid)), I-123 MIBG scans (estimated 60 cGy to thyroid), and immunotherapy. Potassium iodide was given as thyroid protection for MIBG scans. Radiation was complete 16 months prior and she was declared disease free from her neuroblastoma 8 months prior to detection of thyroid nodule.
At initial otolaryngology visit (4 years of age), a right thyroid nodule was palpable on examination. Thyroid function tests were within normal ranges. A thyroid ultrasound demonstrated a 2.9 x 1.4 x 1.8cm heterogeneous solid mass in the right lobe of the thyroid. Ultrasound guided fine needle aspiration (FNA) showed follicular neoplasm by The Modified Bethesda System for Reporting Thyroid Cytopathology. Molecular mutations (BRAF, RAS, PAX8/PPARg, and RET/PTC) were not detected in the FNA sample. Immunostains performed on the FNA excluded neuroblastoma. A right thyroidectomy was performed. Histopathology showed follicular variant of PTC. Subsequent completion thyroidectomy was uncomplicated.
Conclusion: This is the shortest duration from NB treatment to detection of thyroid cancer in a child that we are aware of. Radiation doses to the thyroid were low and associated with <1% risk of thyroid cancer in the general population. Therefore, it is unlikely that these relatively low radiation doses are responsible for the development of PTC in this child. More likely, this child possesses genetic and/or environmental susceptibility for tumor development. Genetic studies are proceeding to assess for potential risk factors responsible for her apparent susceptibility to tumor formation.
Nothing to Disclose: MAB, JS, PHS, RMW, TW, JJ, SC, JP, MD, SEM, YEN, SFW
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