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

Yıl 2023, Cilt: 86 Sayı: 4, 282 - 287, 01.12.2023

Hülya Hacişahinoğulları Elif İnan Balcı Ahmet Yalın İşcan Gülşah Yenidünya Yalın Özlem Soyluk Selçukbiricik İsmail Cem Sormaz Firdevs Baş Ayşe Kubat Üzüm Yasemin Giles Şenyürek Şükran Poyrazoğlu Nurdan Gül

https://doi.org/10.26650/IUITFD.1331706

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

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

Kaynakça

• Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 2014;64(2):83-103. google scholar
• Vaccarella S, Lortet-Tieulent J, Colombet M, Davies L, Stiller CA, Schüz J, et al. Global patterns and trends in incidence and mortality of thyroid cancer in children and adolescents: a population-based study. Lancet Diabetes Endocrinol 2021;9(3):144-52. google scholar
• Qian ZJ, Jin MC, Meister KD, Megwalu UC. Pediatric thyroid cancer incidence and mortality trends in the United States, 1973-2013. JAMA Otolaryngol Head Neck Surg 2019;145(7):617-23. google scholar
• Kebebew E. Hereditary non-medullary thyroid cancer. World J Surg 2008;32(5):678-82. google scholar
• Stack BC Jr, Twining C, Rastatter J, Angelos P, Baloch Z, Diercks G, et al. Consensus statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS-ES) on pediatric benign and malignant thyroid surgery. Head Neck 2021;43(4):1027-42. google scholar
• Al-Qahtani KH, Tunio MA, Al Asiri M, Aljohani NJ, Bayoumi Y, Riaz K et al. Clinicopathological features and treatment outcomes of differentiated thyroid cancer in Saudi children and adults. J Otolaryngol Head Neck Surg 2015;44:48. google scholar
• Hay ID, Johnson TR, Kaggal S, Reinalda MS, Iniguez-Ariza NM, Grant CS et al. Papillary thyroid carcinoma (PTC) in children and adults: comparison of initial presentation and long-term postoperative outcome in 4432 patients consecutively treated at the Mayo Clinic during eight decades (1936-2015). World J Surg 2018;42(2):329-42. google scholar
• Francis GL, Waguespack SG, Bauer AJ, Angelos P, Benvenga S, Cerutti JM et al. American thyroid association guidelines task force. Management guidelines for children with thyroid nodules and differentiated thyroid cancer. Thyroid 2015;25(7):716-59. google scholar
• Dermody S, Walls A, Harley EH Jr. Pediatric thyroid cancer: an update from the SEER database 2007-2012. Int J Pediatr Otorhinolaryngol 2016;89:121. google scholar
• van de Berg DJ, Kuijpers AMJ, Engelsman AF, Drukker CA, van Santen HM, Terwisscha van Scheltinga SCEJ et al. Long-term oncological outcomes of papillary thyroid cancer and follicular thyroid cancer in children: a nationwide population-based study. Front Endocrinol (Lausanne) 2022;13:899506. google scholar
• Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid 2017; 27:751–56. google scholar
• Hogan AR, Zhuge Y, Perez EA, Koniaris LG, Lew JI, Sola JE. Pediatric thyroid carcinoma: incidence and outcomes in 1753 patients. J Surg Res 2009;156(1):167-72. google scholar
• Harach HR, Williams ED. Childhood thyroid cancer in England and Wales. Br J Cancer 1995;72(3):777-83. google scholar
• Taylor AJ, Croft AP, Palace AM, Winter DL, Reulen RC, Stiller CA et al. Risk of thyroid cancer in survivors of childhood cancer: results from the British Childhood Cancer Survivor Study. Int J Cancer 2009;125(10):2400-5. google scholar
• Dias Lopes NM, Mendonça Lens HH, Armani A, Marinello PC, Cecchini AL. Thyroid cancer and thyroid autoimmune disease: A review of molecular aspects and clinical outcomes. Pathol Res Pract 2020;216(9):153098. google scholar
• Anil C, Goksel S, Gursoy A. Hashimoto’s thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study. Thyroid 2010;20(6):601-6 google scholar
• Cherella CE, Richman DM, Liu E, Frates MC, Modi BP, Zendejas B et al. Predictors of bilateral disease in pediatric differentiated thyroid cancer. J Clin Endocrinol Metab 2021;106(10):e4242-50. google scholar
• Wang Z, Chen JQ, Liu JL, Qin XG. Clinical impact of BRAF mutation on the diagnosis and prognosis of papillary thyroid carcinoma: a systematic review and meta-analysis. Eur J Clin Invest 2016;46(2):146-57. google scholar
• Poyrazoğlu Ş, Bundak R, Baş F, Yeğen G, Şanlı Y, Darendeliler F. Clinicopathological Characteristics of Papillary Thyroid Cancer in Children with Emphasis on Pubertal Status and Association with BRAFV600E Mutation. J Clin Res Pediatr Endocrinol 2017;9(3):185-93 google scholar
• Giles Şenyürek Y, İşcan Y, Sormaz İC, Poyrazoğlu Ş, Tunca F. The role of American Thyroid Association Pediatric Thyroid Cancer Risk Stratification and BRAFV600E Mutation in predicting the response to treatment in papillary thyroid cancer patients ≤18 Years Old. J Clin Res Pediatr Endocrinol. 2022;14(2):196-206. google scholar
• Marti JL, Jain KS, Morris LG. Increased risk of second primary malignancy in pediatric and young adult patients treated with radioactive iodine for differentiated thyroid cancer. Thyroid 2015;25(6):681–7. google scholar