Differentiated Thyroid Carcinoma in Children and Adolescents: A Clinicopathologic Analysis of 67 Cases
DT Yin, M Jin, QZ Wang, RL Shen, G He. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Ohio State University, Columbus, OH
Background: Recently, the incidence of differentiated thyroid carcinoma (DTC), including papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), has increased in children and young adults. As DTC's clinic, pathologic, and prognostic features in children and adolescences are different from that in adults, we report 67 case of DTC in children and young adolescence.
Design: Retrospective review and analysis of clinic, pathologic and follow-up results of 67 patients under 20 years old with DTC between 2000 to 2005. On review and analysis, we used the WHO classification of thyroid carcinoma to categorize the PTC and FTC.
Results: Among 67 cases, 15 were male and 52 female (M:F=1:3.5), of them, 8 of 4∼<12 years, 31 of 12∼<16, 28 of 16∼20, with history of painless neck mass of 1 month to 6 years, 10 with increased neck lymph nodes as first sign, and 3 hoarseness. Pre-op color-Doppler ultrasound revealed solid lesion in 53 cases (79.1%), 14 with cystic changes and papillary projections, 27 with ipsilateral and 6 bilateral increased sizes of regional lymph nodes. No remote metastasis were identified. Pre-op FNA were performed in 49 cases, 39 suggestive for malignancy, and 18 cases with intra-op frozen section, 16 diagnosed malignancy. For surgical treatment: 12 had lobectomy with ischmus resection, 23 lobectomy with ischmus and opposite subtotal lobectomy, 32 radical resections. Of the 67 cases, pathological diagnosis were: PTC in 42, FTC in 17, PTC combined with FTC in 8. Lymph node metastasis were confirmed in 29 cases (43.3%), of them, 6 (9%) being bilateral thyroid carcinoma and bilateral node positive. All patients survived well and follow up with no recurrence or remote metastasis, except one patient had contralateral lymph node metastasis 2 years after surgery and underwent regional neck dissection.
Conclusions: DTC in children and adolescence shows non-specific symptom in clinic, and pre-operative diagnosis is difficult. FNA under the guidance of ultrasounde can reach a specific diagnosis in 83∼91%, intra-operative frozen section can establish a definitive diagnosis, and help for selection of the correspondent surgical procedures. Short term follow-up shows the children and adolescence with DTC had early and therapeutic surgery had a good prognosis.
Category: Head & Neck
Wednesday, March 24, 2010 9:30 AM
Poster Session V # 166, Wednesday Morning