Multiple adenomas of the thyroid occurring 20 years after successful radiotherapy for neuroblastoma in the cervical lymph-nodes

The development of thyroid adenoma or carcinoma in children or young adults some years after exposure to ionizing radiation is a well-documented relationship. Most of the reported cases occurred after radiation for benign conditions (Pifer and Hempelmann, 1964) or after exposure to radioactive fallout (Conard, Dobyns and Sutow, 1970). Cases occurring after successful treatment of childhood malignant disease are rare. Three cases following the treatment of medulloblastoma (Raventos and Duszynski, 1963; Andrews and Kerr, 1965), one case treated as a medulloblastoma but subsequently found to be a cystic astrocytoma (Löken, 1958) and one case following treatment of a lymphoma (Rabinowitz and Katz, 1958) have been reported. R.B., female. At the age of six months she was noticed to have a swelling in the left side of her neck. She was admitted to the Chelmsford and Essex Hospital in August 1949, and the swelling was found to consist of a number of large firm lymph-nodes. A node was removed for biopsy and was reported to be lipoid reticulosis. This was never confirmed. No treatment was given and the nodes remained about the same size until May 1952 when she was about three years old. The cervical nodes then started to enlarge rapidly. A further node was removed for biopsy and histological examination showed it to contain neuroblastoma. This diagnosis was confirmed by the Consultant Pathology Panel of The London Hospital (Figs. 1 and 2). Investigations : chest X ray—no abnormality; IVP—no abnormality.