Background: Thyroid nodules (TN) are rare in children but often show more aggressive features than in adults. Irradiated childhood cancer survivors (CCS) are at risk for malignant thyroid nodules.
Objective and hypotheses: To retrospectively compare the incidence of differentiated thyroid cancer (DTC), the clinical onset and the medium-term follow-up in a pediatric population (EC <18 years), with and without risk factors examined for TN, among 1990 and 2014 in our center.
Method: We compared data of 52 patients (pts) (group 1) without DTC risk factors (genetic and/or iatrogenic) with 167 consecutive CCS (group 2) previously head/neck irradiated. All pts underwent clinical, laboratory and thyroid ultrasound evaluations. Fine needle ago-biopsy (FNAB) was performed in pts with suspicious ultrasonography. Pts with positive FNAB underwent total thyroidectomy and one or more cycles of Radioiodine Therapy (RT).
Results: Group 1: 15/52 pts (29%) showed DTC (12 papillary carcinoma, 3 follicular variants). Follow-up data are available for 12/15 pts. 50% of pts showed lymphadenopathy and/or an already palpable TN at diagnosis occurred during routinary pediatric visits. Metastases were found in locoregional lymph nodes (7/12 pts) and in lungs in 4/12 pts. 7/12 pts needed more than a course of RT and only 8/12 pts were free of disease at the last control (range 10.5 23 yrs). Group 2: in 89/167 pts (53%) TN were found at 8.4±4 yrs from irradiation. 15/89 pts (17%) showed DTC (9 papillary carcinoma, 6 follicular variants). Metastases were found only in locoregional lymph nodes in 9/15 cases (60%). At last control (range 17 28 yrs), all pts were free of disease.
Conclusion: Our data confirm the aggressive nature of the DTC in children. The good prognosis is ensured by an early diagnosis and the clinical evaluation of the cervical region should be recommended as part of the routine pediatric visit.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology