Parotid carcinoma as a second malignancy after treatment of childhood acute lymphoblastic leukemia

The occurrence of second malignant neoplasms (SMN) in children who survive their primary malignancy is a major cause for concern. Two children with di agnoses of intermediate-risk acute lymphoblastic leukemia (ALL) at 22 month s and 2 years of age were treated with multiagent chemotherapy and prophyla ctic cranial irradiation. They experienced painless parotid swelling 6 and 7 years after successful treatment of the ALL. The patients underwent total parotidectomy, and a diagnosis of mucoepidermoid carcinoma was made. Both patients experienced transient facial nerve paresis. The incidence of SMN i n children successfully treated for primary malignancies is 3% to 12%. Sali vary gland tumors are being increasingly described in this setting. Long-te rm followup for survivors of childhood ALL is recommended with prompt asses sment and resection of parotid swellings, particularly in children who have received cranial irradiation.