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Title: Thyroid lesions in children and adolescents after the Chernobyl disaster: Implications for the study of radiation tumorigenesis

Abstract

Eight years after the Chernobyl nuclear accident, the most obvious effect is manifested by an increase in the prevalence of thyroid gland diseases in the exposed children and adolescents. In this study, we describe a comparative analysis of epidemiological, clinical, and morphological features of 92 malignant and 59 benign thyroid lesions from patients 5-18 yr of age exposed to radiation in Belarus as a result of the Chernobyl disaster. All of them were operated at the same institution during the period from September 1991 through December 1992. The highest number of patients that subsequently developed thyroid carcinomas was in the group that was less that 1 yr of age at the time of Chernobyl, and this number decreased progressively through age 12 yr. Conversely, none of the patients with benign lesions only was less than 2 yr old at the time of the accident, and an exposure age of 5-6 yr was a threshold separating significant prevalence of malignant tumors in younger children from the more frequently benign lesions in older patients (P {le} 0.001). Fifty-two percent of the children with carcinomas and only 24% with benign lesions (P {le} 0.005) were residents of the Gomel region, which is themore » most contaminated in Belarus. The morphology of thyroid tissue adjacent to carcinomas showed a high prevalence of multinodular and diffuse changes, but not of adenomas or solitary adenomatoid nodules. There was a high prevalence of focal micropapillary hyperplasia with graded degrees of severity, which we hypothesize may correspond to precursors for papillary thyroid carcinoma in post-Chernobyl radiation-associated tumors. 36 refs., 3 figs., 4 tabs.« less

Authors:
;  [1];  [2]
  1. Univ. of California School of Medicine, Los Angeles, CA (United States)
  2. Brown Univ. School of Medicine, Providence, RI (United States)
Publication Date:
OSTI Identifier:
393903
Resource Type:
Journal Article
Resource Relation:
Journal Name: Journal of Clinical Endocrinology and Metabolism; Journal Volume: 81; Journal Issue: 1; Other Information: PBD: Jan 1996
Country of Publication:
United States
Language:
English
Subject:
56 BIOLOGY AND MEDICINE, APPLIED STUDIES; 57 HEALTH AND SAFETY; 55 BIOLOGY AND MEDICINE, BASIC STUDIES; THYROID; NEOPLASMS; CHERNOBYLSK-1 REACTOR; REACTOR ACCIDENTS; RADIATION ACCIDENTS; IODINE 131; RADIONUCLIDE KINETICS; CHILDREN; RADIATION DOSES; DELAYED RADIATION EFFECTS; RADIOSENSITIVITY; CARCINOGENESIS; RISK ASSESSMENT

Citation Formats

Nikiforov, Y., Fagin, J.A., and Gnepp, D.R.. Thyroid lesions in children and adolescents after the Chernobyl disaster: Implications for the study of radiation tumorigenesis. United States: N. p., 1996. Web. doi:10.1210/jc.81.1.9.
Nikiforov, Y., Fagin, J.A., & Gnepp, D.R.. Thyroid lesions in children and adolescents after the Chernobyl disaster: Implications for the study of radiation tumorigenesis. United States. doi:10.1210/jc.81.1.9.
Nikiforov, Y., Fagin, J.A., and Gnepp, D.R.. 1996. "Thyroid lesions in children and adolescents after the Chernobyl disaster: Implications for the study of radiation tumorigenesis". United States. doi:10.1210/jc.81.1.9.
@article{osti_393903,
title = {Thyroid lesions in children and adolescents after the Chernobyl disaster: Implications for the study of radiation tumorigenesis},
author = {Nikiforov, Y. and Fagin, J.A. and Gnepp, D.R.},
abstractNote = {Eight years after the Chernobyl nuclear accident, the most obvious effect is manifested by an increase in the prevalence of thyroid gland diseases in the exposed children and adolescents. In this study, we describe a comparative analysis of epidemiological, clinical, and morphological features of 92 malignant and 59 benign thyroid lesions from patients 5-18 yr of age exposed to radiation in Belarus as a result of the Chernobyl disaster. All of them were operated at the same institution during the period from September 1991 through December 1992. The highest number of patients that subsequently developed thyroid carcinomas was in the group that was less that 1 yr of age at the time of Chernobyl, and this number decreased progressively through age 12 yr. Conversely, none of the patients with benign lesions only was less than 2 yr old at the time of the accident, and an exposure age of 5-6 yr was a threshold separating significant prevalence of malignant tumors in younger children from the more frequently benign lesions in older patients (P {le} 0.001). Fifty-two percent of the children with carcinomas and only 24% with benign lesions (P {le} 0.005) were residents of the Gomel region, which is the most contaminated in Belarus. The morphology of thyroid tissue adjacent to carcinomas showed a high prevalence of multinodular and diffuse changes, but not of adenomas or solitary adenomatoid nodules. There was a high prevalence of focal micropapillary hyperplasia with graded degrees of severity, which we hypothesize may correspond to precursors for papillary thyroid carcinoma in post-Chernobyl radiation-associated tumors. 36 refs., 3 figs., 4 tabs.},
doi = {10.1210/jc.81.1.9},
journal = {Journal of Clinical Endocrinology and Metabolism},
number = 1,
volume = 81,
place = {United States},
year = 1996,
month = 1
}
  • Studies after the Chernobyl Disaster revealed an increased level of chromosome aberrations in cultured lymphocytes of the inhabitants of the radiation-polluted regions. This work estimates the resolution capacity of a method of accounting for chromosomal aberrations in human lymphocyte culture. The results reveal population effects of low-dose chronic irradiation by radioactive sediments three and more years after the Chernobyl Disaster. 13 refs., 2 tabs.
  • We report on 49 patients younger than 18 years at diagnosis, of 776 patients with thyroid cancer, seen in our institution in the last 17 years. Female/male ratio was 2.2:1. Histologic type was papillary in 44, follicular in 4, and medullary in 1. Initial treatment was near-total thyroidectomy with or without neck dissection. Surgical complications (vocal cord palsy, permanent hypoparathyroidism, or both) were found in 25 patients and were usually associated with more advanced primary tumors. At surgery, node metastases were present in 73% of the patients and lung metastases, detected by chest x ray films, in 6%. Patients weremore » treated with thyroid suppressive therapy and, except the one with medullary cancer, with radioiodine (131I) therapy. After a mean follow-up of 7.7 +/- 4.4 years (range, 1 to 17 years), one patient with lung metastases died of respiratory failure. Of 36 patients who have been followed up more than 4 years, 22 (61.1%) are now cured, and 14 have metastases (to lymph nodes, 2; to nodes and lung, 10; and to lung, 2). Since 1977 serum thyroglobulin (Tg) was used routinely as a tumor marker for differentiated thyroid cancer. After operation, Tg was elevated in all patients both not receiving (mean +/- SE, 902 +/- 380 ng/ml) and receiving (44 +/- 15 ng/ml) suppressive therapy; after 131I treatment, serum Tg dropped to 104 +/- 50 and 7.3 +/- 1.7 ng/ml, without and with suppressive therapy, respectively. Of 11 patients with lung metastases treated with 131I, respiratory function, as assessed by means of spirometry, was normal in three, mildly reduced in six, and severely impaired in two (including the one who died). In conclusion, our study indicates that thyroid cancer in young patients is rather advanced at initial examination and usually associated with node and, less frequently, lung metastases.« less
  • An analysis of differentiated thyroid carcinomas in children and adolescents revealed that the incidence was 3.05% of total number of patients with differentiated thyroid cancers in all age groups. There was a female preponderance. The incidence of papillary, follicular and papillary with follicular elements was equal. There were no papillary carcinomas observed in children younger than 10 years. The predominant mode of presentation was a solitary nodule of thyroid and some of them had associated cervical adenopathy. A considerable number presented with only cervical adenopathy. The incidence of nodal metastases was 50% at time of presentation and lung involvement wasmore » present in 15% of children at the time of diagnosis. Radioiodine treatment was given in 70% of children. Ablation was achieved in 86% of patients given two doses of radioiodine (200 millicuries). The more resistant cases were those with lung and nodal metastases. There was complete ablation in 100% with only residual thyroid tissue, 83% in those with associated nodal metastases, and 57% in those with lung involvement. Average duration of follow-up was 10.3 years (range, 2 to 19 years). Recurrence rate or relapse was observed in 8.5% and was in the regional nodes. There was no recorded mortality due to the disease.« less