COURSE OF PAPILLARY THYROID CARCINOMA DIAGNOSED IN CHILDHOOD AND ADOLESCENCE AND FOLLOWED THROUGH ADULTHOOD: EXPERIENCE FROM A TERTIARY REFERRAL CENTER

Öz

Objective: Differentiated thyroid cancer accounts for 1.5% of all pediatric malignancies. Papillary thyroid cancer (PTC) is the most common subtype and is associated with more advanced disease at diagnosis compared to adults. This study aimed to identify long-term outcomes of pediatric PTC. Material and Method: Records of 30 patients with PTC diagnosed in childhood and adolescence and followed up at the Istanbul Faculty of Medicine were reviewed retrospectively. Result: The mean age of 30 patients (21 females, 9 males) at diagnosis was 14.7±2.3 years. The mean duration of follow-up was 10.6±3.8 years. The patients underwent total thyroidectomy (n=9), total thyroidectomy with central lymph node dissection (n=9), or total thyroidectomy with central and lateral lymph node dissection (n=12). The mean tumor diameter was 1.6±1.5 cm and was microcarcinoma in 12 of the patients. There were five patients with T2 and two patients with T3 disease. At diagnosis, half of the patients had lymph node metastasis to the neck or upper mediastinum (N1a=5, N1b=10), and two also had lung metastasis. Post-operative radioactive iodine (RAI) treatment was administered to 22 patients, the median cumulative dose was 150 mCi (range 50 to 1100)]. Sixteen patients had excellent responses following single (n=13) or multiple (2 for persistent and 1 for recurring disease after 8.3 years) RAI administrations. The remaining three patients had structural incomplete and three had indeterminate responses. Conclusion: Although PTC presented at a more advanced stage in childhood and adolescence, the response to treatment was fairly good with appropriate management.

Anahtar Kelimeler

• Papillary thyroid cancer
• thyroid
• pediatric
• radioactive iodine

ÇOCUKLUK VE ADÖLESAN DÖNEMDE TANI KONULAN ERİŞKİNLİK DÖNEMİ BOYUNCA TAKİP EDİLEN PAPİLLER TİROİD KARSİNOMUNUN SEYRİ: BİR ÜÇÜNCÜ BASAMAK MERKEZ DENEYİMİ

Öz

Amaç: Diferansiye tiroid kanseri, tüm pediatrik malignitelerin %1,5'ini oluşturur. Papiller tiroid kanseri (PTK) en sık görülen alt tiptir ve tanı anında hastalık evresi erişkinlere kıyasla daha ileridir. Bu çalışmanın amacı, pediatrik PTK'nin uzun vadeli sonuçlarını değerlendirmekti. Gereç ve Yöntem: İstanbul Tıp Fakültesi'nde takip edilen çocukluk ve adölesan döneminde PTK tanısı konulan 30 hastanın retrospektif olarak verileri incelendi. Bulgular: Otuz hastanın (21 kadın, 9 erkek) tanı anındaki ortalamayaşı 14,7±2,3 idi. Ortalama takip süresi 10,6±3,8 yıldı. Dokuz hastaya total tiroidektomi, dokuz hastaya santral lenf nodu diseksiyonu ile total tiroidektomi, 12 hastaya ise santral ve lateral lenf nodu diseksiyonu ile total tiroidektomi uygulandı. Ortalama tümör çapı 1,6±1,5 cm idi ve 12 hastada mikrokarsinom saptandı. T2 hastalığı olan beş hasta ve T3 hastalığı olan iki hasta vardı. Tanı sırasında hastaların yarısında boyun veya üst mediastende lenf nodu metastazı (N1a=5, N1b=10), iki hastada da ayrıca akciğer metastazı vardı. Ameliyat sonrası 22 hastaya radyoaktif iyot (RAI) tedavisi uygulandı, ortanca kümülatif doz 150 mCi (aralık 50-1100) idi. Hastaların 13'ü tekli doz, 3'ü (2 hasta persistan hastalık, 1 hasta 8,3 yıl sonra gelişen nüks hastalık nedeniyle) çoklu doz RAI uygulamasının ardından mükemmel yanıt verdi. Kalan üç hastada yapısal inkomplet ve üç hastada indetermine yanıt alındı. Sonuç: PTK çocukluk ve ergenlik döneminde daha ileri evrede ortaya çıksa da uygun hastalık yönetimiyle tedaviye yanıt oldukça iyiydi.

Anahtar Kelimeler

• Papiller tiroid kanseri
• tiroid
• pediatrik
• radyoaktif iyot

Kaynakça

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