Recurrent ‘nodular goitre’ in children

Abstract

OWING to the infrequency with which nodular goitre occurs in children, 3 cases of recurrent ' adenomata ' which have been encountered are presented and their pathological nature, prognosis, and treatment discussed. Owing to the exigencies of war, it is regretted that clinical details are sparse. CASE REPORTSCase I.-A male child born in 1911 was first seen in 1920, at the age of 9. He was brought to the Out-patient Department complaining of a symptomless swelling in the neck which had first been noticed at the age of 6 and had subsequently for the ensuing three years gradually increased in size. He was operated upon in the same year (1920), a nodular goitre being removed by partial thyroidectomy (Mr. Gordon Bryan).The pathological report showed that nodules varied in size and consistency, but some were paler in colour and more solid. The microscopical picture showed the more solid nodules to be composed of diffuse sheets of cells, but always showing a tendency to form acini (Fig. 605). There was a variation in staining properties of the nuclei, but mitoses were infrequent. Neither capsular nor blood-vessel invasion was seen. Other nodules showed large vesicles with a tendency to papillary projections. In the surrounding thyroid tissue were tiny nodules consisting of small acini (Fig. 606). No colloid was seen in the specimen.Almost immediately after the patient's discharge from hospital a reappearance of the swelling in the neck was noticed and thirteen months later he was re-admitted for a further operation ( I~z I ) , more thyroid tissue being removed (Mr. Zachary Cope). Pathological examination gave a picture almost identical with those of the earlier sections (Fig. 607). After this second operation nothing untoward occurred until 1929, when, at the age of 18, he again sought advice for his steadily enlarging thyroid gland. Yet a third thyroid resection was performed by Mr. Gordon Bryan.It has not proved possible since to trace this patient in person, but information from the Registrar-General's office leads us to assume that he is still alive. The pathological report on the tissue removed at the third operation was very similar to that in the first instance. Nodules up to 2.5 cm. in diameter had been removed, the largest of these being cystic, the smaller ones solid ( Fig. 608). Some consisted of acini of varying sizes lined by cubical epithelium (Fig. 609), but others showed the same characteristics as those already described.Case 2.-A male child, born in 1918, was first seen at the age of 13 years in 1931. He then complained of a swelling of the neck which was said to have been present since birth, but which had been increasing markedly during the last few years. He had had no dysphagia and there were no symptoms or signs suggestive of thyrotoxicosis. He was 4 ft. 4 in. in height and weighed only 4 st. He had never lived in a goitrous district, but had had a sister who was operated upon for a swelling of the thyroid ( ? adenoma) when 9 years old. Subsequent to this operation the goitre had recurred and two y...