Occurrence of thyroid papillary carcinoma in young patients. A Chernobyl connection?

The risk of thyroid papillary carcinoma is increased by external radiation particularly in children under 15 years of age as shown by a marked increas e in those exposed to radiation after Chernobyl, We were recently confronte d in Belgium over a short period with four patients (3 F, 1 M) with papilla ry thyroid carcinoma who were aged 10 years, 2 months, 2 years and 6 years when the Chernobyl accident occurred. We thus raise the question of a possi ble relationship, The patients were aged 17, 11, 10, 19 years at presentati on. They all presented fortuitously over 3 years which was a very unusual i ncrease in our extensive experience in thyroid surgery (62 cases of thyroid cancer among 1014 thyroidectomies in adults vs 4 cases in 18 children sinc e the Chernobyl accident in 1986), Two out of the four patients had psammom a bodies (identifiable on CT scanning and ultrasound) and thyroglobulin aut oantibodies (TgAb), The first patient had positive lymph nodes at the time of surgery, The incidence of thyroid cancers in Belarus and Ukraine rose ju st 4 years after the Chernobyl disaster; because radioactive clouds passed over Belgium, we wonder whether the occurrence of thyroid cancer in our pat ients could be related to this irradiation. The mechanism of increased inci dence of radiation-induced thyroid cancer is thought to be due to rearrange ment of the tyrosine kinase domains of the RET and TTK genes. The other imp ortant similarities in our patients are the presence of psammoma bodies tha t can be visualized on radiological examination and the presence of TgAb th at are more frequent in differentiated thyroid cancers. Whether or not thes e cases reflect an increased incidence in the population as a whole, clinic ians must remain vigilant for this rare but curable cancer in young patient s, especially if suggestive radiological features or TgAb are present.