Differentiated thyroid carcinoma in children and adolescents

Harness, Jay K.; Thompson, Norman W.; McLeod, Michael K.; Pasieka, Janice L.; Fukuuchi, Atsushi

doi:10.1007/bf02067317

Cited by 168 publications

(131 citation statements)

References 5 publications

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“…Most thyroid cancers in children are papillary (PTC), followed by follicular (FTC) and, more rarely, medullary carcinoma [19,20]. Among Indian studies, Samuel et al found pediatric DTC at a frequency of 30% PTC and 30% mixed papillary and follicular variants [10]; whereas Kumar and Bal reported PTC in 85% of the cases [9].…”

Section: Pathologymentioning

confidence: 99%

Pediatric Thyroid Cancers: An Indian Perspective

Chaukar

Vaidya

2012

Indian J Surg Oncol

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Pediatric thyroid cancer is a rare entity accounting for less than 5% of all thyroid cancers. This intriguing disease is characterized by advanced presentation, coupled with frequent lymph nodal metastases and often pulmonary metastases. It perhaps exhibits a distinct biology and behaviour, because in spite of its aggressiveness, survival is extremely good. This mandates meticulous treatment decisions that are well executed, because the complications of therapy in patients with good survival may spell prolonged morbidity. Being an unusual disease, it is unlikely that level I evidence guiding the management will come forth. There have been controversies regarding management, and the current consensus comes from large prospective studies. There have been only a few studies from India detailing pediatric thyroid cancers. In the current discussion, we review the existing evidence about pediatric thyroid cancers, and try to have an Indian perspective at the problem.

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Section: Pathologymentioning

confidence: 99%

Pediatric Thyroid Cancers: An Indian Perspective

Chaukar

Vaidya

2012

Indian J Surg Oncol

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“…Thyroid carcinoma occurrence is negligible in very young children, although the literature contains isolated clinical cases in 4-6-month-old infants or even neonates (Harness et al 1992, Newman et al 1998, Schlumberger et al 2004a. Age-specific incidence rates diverge for males and females starting at age 10 years, and increase substantially for females from age 13-14 years (Harach & Williams 1995, Bernstein & Gurney 1999 (Fig.…”

Section: Epidemiology Of Juvenile Dtcmentioning

confidence: 99%

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Jarząb¹,

Handkiewicz-Junak²,

Włoch³

2005

Endocr Relat Cancer

168

160

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Well under 15% of differentiated thyroid carcinoma (DTC) is diagnosed at £18 years of age. The population is heterogenous and the differences between prepubertal children and pubertals and adolescents are to be considered. Although very little has been reported on children with sporadic DTC under the age of 10 years, juvenile DTC has at least some undeniable differences with adult DTC: (1) larger primary tumor at diagnosis; (2) metastatic pattern and features, namely: (a) greater prevalence of neck lymph node and distant metastases at diagnosis, (b) lungs almost the sole distant metastatic site, (c) pulmonary metastases nearly always functional; (3) closer-to-normal and more frequent sodium-iodide symporter (NIS) expression; and (4) higher recurrence rate but longer overall survival. These differences are especially distinct in prepubertal children. The goals of primary treatment of juvenile DTC are to eradicate disease and extend not only overall, but recurrence-free survival (RFS). Extending RFS is itself a desirable goal in children because it improves quality-of-life, alleviates anxiety during psychologically formative years, reduces medical resource consumption, and may increase overall survival. Primary treatment of DTC generally comprises a combination of surgery, radioiodine ( 131 I) ablation, and thyroid hormone therapy applied at varying levels of intensity. Therapeutic decision-making must rely on retrospective adult and/or pediatric outcome studies and on treatment guidelines formulated mostly for adults. Differences between juvenile and adult DTC and physiology dictate distinct treatment strategies for children. We, and many others, advocate a routine intensive approach because of the more advanced disease at diagnosis, propensity for recurrence, and greater radioiodine responsiveness in children, as well as published evidence of significant survival benefits, especially regarding RFS. This intensive approach consists of total thyroidectomy and central lymphadenectomy in all cases, completed by modified lateral lymphadenectomy when necessary and followed by radioiodine administration. However, absence of prospective studies and of universal proof of overall causespecific survival benefits of this approach have led some to propose more conservative strategies. Most European centers give radioiodine ablation to the vast majority of juvenile DTC patients. Ablation seeks to destroy any residual cancer, including microfoci, as well as healthy thyroid remnant. Large studies have documented the procedure to decrease cause-specific death rates and, in children, to significantly lessen locoregional recurrence rates (by factors of 2-11) independent of the extent of surgery. There is universal agreement on treating inoperable functional metastases with large radioiodine activities. Treatment is especially effective in small tumor foci up to 1 cm in diameter, and should be administered every 6-12 months until complete response, loss of functionality, or attainment of cumulative activities between 18.5-3...

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“…Studies of large series of thyroid cancer in young children have been largely confined to major tertiary referral centres and have usually concentrated on the clinical behaviour and treatment rather than pathology Rosvoll, 1961, 1970;Buckwalter et al. 1981;Schlumberger et al, 1987;Zimmerman et al, 1988;Harness et al, 1992;Samuel and Sharma, 1991). Thyroid cancer in children is however, currently assuming greater importance, because of the reports of a greatly increased frequency in children exposed to fallout in the areas around Chernobyl (Baverstock et al, 1992;Kazakov et al, 1992;Williams et al, 1993).…”

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confidence: 99%

Childhood thyroid cancer in England and Wales

Harach

Williams²

1995

Br J Cancer

160

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Summary A total of 154 cases of thyroid cancer in children under 15 were registered in England and Wales over a period of 30 years. an incidence of about 0.5 per million per year. A total of 4.5 cases per year were registered in 1963-72. 4.9 in 1973-82 and 5.8 in 1983-92. A rapid rnse in incidence with age occurred after the age of 5. Malignancy was confirmed in 92% of the cases in which tissue was available. Of these. 68% were papillary carcinomas. 110% follicular carcinomas and 17% medullarv carcinomas. There were two spindle cell tumours with mucous cysts and one teratoma. The increased frequency but small size of medullary carcinomas in the second half of the period suggested that this increase was due to the introduction of screening; it accounted for most of the rise in crude incidence rates with time. The sex ratio (F:M) in all registered cases in the differentiated follicular cell carcinoma groups in children aged under 10 was 1.2:1. and 3.6:1 in the older children. Five children with differentiated thyroid cancer of follicular cell origin died up to 17 years after diagnosis. Two of the eight children aged 9 or less with a 20 year follow-up died. compared with three of 28 older children. An unusual group of differentiated carcinomas showed solid or follicular architecture. These tumours were unencapsulated. often widely invasive, contained psammoma bodies but little or no papillary architecture and the nuclei often lacked prominent grooving. This childhood type of papillary carcinoma contrasted with the classical type commonly found in the adult, which was present in none of 13 confirmed papillary carcinomas in children aged less than 10. compared with 20 of 35 older children. These observations show that thyroid carcinoma in very young children has a different spectrum of histological types from both older children and adults. From the age of about 10 well-differentiated papillary carcinomas rapidly increase in frequency in females. so that the other types come to form only a small proportion of the total. These differences. and the lower incidence but poorer prognosis of thyroid carcinoma in men and the poorer prognosis in post-as compared with premenopausal women. are compatible with a major role for sex hormones in thyroid carcinogenesis in females during the reproductive period. This study documents the incidence of childhood thyroid cancer in England and Wales. explains the rise in crude incidence rates. shows differences between carcinomas in children under and over the age of ten which may correlate with puberty. and draws attention to an unusual aggressive type of childhood papillary carcinoma. It illustrates the value to crude registry data of a pathology revies.

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Differentiated thyroid carcinoma in children and adolescents

Cited by 168 publications

References 5 publications

Pediatric Thyroid Cancers: An Indian Perspective

Pediatric Thyroid Cancers: An Indian Perspective

Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review

Childhood thyroid cancer in England and Wales

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