Parotid Carcinoma as a Second Malignancy After Treatment of Childhood Acute Lymphoblastic Leukemia

Abstract

An 11-year-old boy with multiply relapsed lymphoblastic disease became transfusion dependent with myelodysplasia and chromosomal abnormalities after 5 years of aggressive therapy. At 5 years of age, he presented with transient idiopathic hypoplastic anemia and neutropenia that spontaneously resolved within a month. Three months later, he experienced lymphoblastic lymphoma in the left parotid region and subsequently experienced disease relapse in his testicles, bone marrow, and central nervous system during a 3-year period. He has received multiagent chemotherapy, autologous peripheral blood stem-cell transplantation, and testicular and whole neuraxis irradiation therapy. After craniospinal irradiation, he did not recover normal bone marrow function. His bone marrow was hypocellular, and he required platelet and erythrocyte transfusions and granulocyte colony-stimulating factor. Marrow cytogenetic studies revealed new multiple translocations. Within a month of the initiation of intravenous amifostine at 200 mg/m2/dose three times a week, his leukocyte count, neutrophil count, and hemoglobin level normalized. His platelet count also improved sufficiently to achieve transfusion independence. He has returned to school and engages in other normal activities for his age. Amifostine may improve hematopoiesis in secondary myelodysplastic syndromes in children.

Salivary gland second cancer after bone sarcoma treatment

“…Salivary gland SMN have been reported after leukemia, Hodgkin's lymphoma [22], neuroblastoma [15], and bone sarcomas [23]. Parotid gland SMN and mucoepidermoid histotypes were the most common, as in the present series.…”

Salivary Gland Neoplasia: A Review for the Practicing Pathologist

“…The best known risk factor is that of radiation exposure as evident in the increased risk in atomic bomb survivors and in patients receiving therapeutic radiation. An increased occurrence in children with leukemias treated with multiagent chemotherapy and prophylactic cranial irradiation has also been noted (1). A dose response effect for low dose irradiation has been shown with a mean latency period of tumor development of 11 years for malignant tumors and 21.5 years for benign tumors (2).…”

Low incidence of second neoplasms among children diagnosed with acute lymphoblastic leukemia after 1983

“…Case reports of parotid gland tumors as second malignancies after treatment of childhood ALL have been described, 53 with patients presenting with painless swelling 6 to 7 years after treatment for ALL. Our cohort was at a 33-fold increased risk for mucoepidermoid carcinoma of the parotid gland, which developed a median of 9 years from diagnosis of ALL, and all 4 patients were alive at the time of this report.…”