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Second Malignancies in Pediatric Patients: Imaging Findings and Differential Diagnosis¹

¹ From the Department of Pediatric Radiology and Institut de Diagnòstic per la Imatge (E.V., A.C., J.P., P.O., J.L.), the Department of Pediatric Oncology (J.S.T.), and the Department of Pediatric Neurosurgery (P.N.), Hospital Materno-Infantil Vall d’Hebron, Psg Vall d’Hebron 112-119, Barcelona E-08035, Spain. Recipient of a Cum Laude award for an education exhibit at the 2002 RSNA scientific assembly. Received February 21, 2003; revision requested April 8 and received June 6; accepted June 6. Address correspondence to E.V. (e-mail: evazquez@cs.vhebron.es).

Therapeutic advances in the treatment of pediatric neoplasms have improved the prognosis but have also increased the risk of developing rare second malignant neoplasms (SMNs). Primary neoplasms that are often associated with SMNs include lymphoma, retinoblastoma, medulloblastoma, neuroblastoma, and leukemia. The most common SMNs are central nervous system (CNS) tumors, sarcomas, thyroid and parotid gland carcinomas, and leukemia, particularly acute myeloblastic leukemia. Genetic predisposition, chemotherapy, and especially radiation therapy are implicated as pathogenic factors in SMN. All survivors of childhood cancer should have lifelong follow-up, preferably with magnetic resonance imaging, which does not require ionizing radiation and provides greater anatomic detail and resolution in the head and neck region and the CNS. A new or progressive lesion may represent recurrence of the primitive neoplastic process, late radiation injury, or, more infrequently, an SMN. Differential diagnosis can be very difficult, and outcome is often fatal. Treatment protocols should be modified to reduce the risk for SMN without compromising the effectiveness of initial therapy. Clinicians should individualize treatment for patients who are genetically predisposed to SMN. In addition, radiologists should be familiar with the long-term consequences of antineoplastic therapy to facilitate diagnosis and anticipate adverse outcomes.

© RSNA, 2003

Index Terms: Chemotherapy, complications • Neoplasms, CT, _**.1211² • Neoplasms, in infants and children, _**.32 • Neoplasms, MR, _**.1214 • Radiations, injurious effects, neoplastic, _**.47

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