SECONDARY PAPILLARY THYROID CARCINOMA IN A NON-IRRADIATED PEDIATRIC LEUKEMIA SURVIVOR: CRITICAL IMPLICATIONS FOR ADVANCED NURSING SURVEILLANCE AND LONG-TERM SURVIVORSHIP PARADIGMS
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.5986Keywords:
Pediatric Acute Lymphoblastic Leukemia, Papillary Thyroid Carcinoma, Secondary Primary Malignancy, Nursing Surveillance, Survivorship Care, Cytotoxic GenotoxicityAbstract
Objectives: This case study aims to document an extraordinary instance of early-onset secondary papillary thyroid carcinoma (PTC) in a non-irradiated pediatric survivor of acute lymphoblastic leukemia (ALL) and to evaluate its implications for advanced oncology nursing surveillance models.
Methods: A descriptive, retrospective single-patient case study design was utilized. Clinical data, including multi-agent chemotherapy dosing protocols (ALL-IC BFM 2009), diagnostic radiologic logs, pre-operative thyroid function assays, and high-resolution ultrasonography parameters, were critically reviewed alongside post-operative histopathological data.
Key Findings: A 3.5-year-old boy achieved molecular remission from B-cell ALL after exclusive chemotherapy, without any cranial or cervical irradiation. Remarkably, only 36 months post-primary diagnosis, proactive nursing physical palpation during a routine follow-up incidentally detected a firm cervical mass. High-resolution ultrasonography and fine-needle aspiration biopsy confirmed a metastatic classical variant of PTC (pT1bN1bM0). The patient successfully underwent a total thyroidectomy and modified cervical lymphadenectomy, achieving stable clinical remission over an 18-month longitudinal observation period.
Conclusions: Secondary metastatic PTC can manifest exceptionally early in pediatric leukemia survivors, completely independent of prior exposure to ionizing radiation. This rapid oncogenesis challenges radiation-centric surveillance paradigms. To prevent diagnostic delays, we recommend the integration of regular, standardized manual thyroid palpation into routine nursing assessments for all pediatric oncology survivors. Future research must prioritize multi-center registries and routine molecular profiling to define chemotherapy-induced genotoxic thresholds and uncover underlying somatic-germline interactions in very young cohorts.
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Copyright (c) 2026 Patryk Obajtek, Sylwia Sanakiewicz, Mikołaj Dubiel, Julia Jasińska, Aleksandra Gródek, Dominik Iskrzyński, Aleksandra Bułat, Wiktoria Dubiel, Julia Iglantowicz
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