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      Cáncer diferenciado de tiroides de tipo folicular en la infancia y adolescencia: A propósito de un caso Translated title: Diferentiated thyroid cancer type folicular in childhood and adolescence: A case report

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          Abstract

          Objetivo: Presentación de un caso clínico de carcinoma folicular de tiroides en un adolescente, patología infrecuente en la población pediátrica y revisión de su manejo. Caso clínico: Paciente masculino de 14 años de edad que consultó por presentar aumento de volumen en región anterior del cuello de rápido crecimiento, 3 meses de evolución, asociado a dolor persistente, disfonía y disfagia. Examen físico: Peso: 65 kg, Talla: 1,68 m, IMC: 23 kg/m². Macrocefálico. Glándula tiroides aumentada de tamaño: 3x4 cm (3N), a expensas de lóbulo derecho, de consistencia aumentada y superficie lisa. No se palparon adenopatías. El ultrasonido (US) tiroideo reportó nódulo que midió 33 x 33 x 32 mm en el lóbulo derecho. Funcionalmente eutiroideo. El estudio citológico del nódulo mediante PAAF reportó neoplasia folicular. En abril del 2014 se le practicó tiroidectomía total, cuya biopsia reportó carcinoma folicular de tiroides mínimamente invasivo, de 4,7 x 4,6 x 3,8 cm. Esta neoplasia se clasificó como T3N0M0 (St I AJCC 2010 <45años), bajo riesgo de recurrencia (ATA 2009), se administró terapia metabólica con yodo radiactivo (150mCi). Conclusión: El riesgo de recurrencia estimado concuerda con las características del bajo riesgo, sin embargo se decidió el manejo terapéutico tomando en cuenta el tamaño de la lesión (mayor de 4 cm) y la agresividad que muestra el cáncer diferenciado de tiroides en éste grupo etario, donde se observa con mayor frecuencia multifocalidad, invasión a la cápsula y metástasis a ganglios linfáticos regionales o a distancia, al momento del diagnóstico.

          Translated abstract

          Objective: To present a case of follicular thyroid carcinoma in an adolescent, uncommon condition in the pediatric population and management review. Clinical case: Male patient 14 years old who consulted for filing increased volume in anterior neck of rapid growth, 3 months of evolution associated with persistent pain, dysphonia and dysphagia. Physical exam: Weight: 65 kg, Height: 1.68 m, BMI 23 kg/m². Macrocephalic. Enlarged thyroid gland size: 3x4 cm (3N) at the expense of right lobe, increased consistency and smooth surface. No lymph nodes were palpated. Ultrasound (US) reported thyroid nodule that measured 33 x 33 x 32 mm in the right lobe. Functionally euthyroid. The cytological study of the nodule FNA reported follicular neoplasm. In April 2014 he underwent total thyroidectomy whose biopsy reported minimally invasive follicular thyroid carcinoma, 4.7x 4.6x 3.8 cm. This neoplasm was classified as T3N0M0 (St I AJCC 2010 <45 years), low risk of recurrence (ATA 2009). Metabolic radioiodine therapy (150 mCi) was administered. Conclusion: The estimated risk of recurrence is consistent with the characteristics of low risk, however the therapeutic management was decided taking into account the size of the lesion (greater than 4 cm) and aggressivity that shows the differentiated thyroid cancer in this group of age where more frequently is observed multifocality, invasion of the capsule and metastasis to regional lymph nodes or distant, at diagnosis.

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          Most cited references31

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          Comprehensive clinical assessment of 740 cases of surgically treated thyroid cancer in children of Belarus.

          A retrospective study was designed to evaluate the results of surgical treatment and follow-up data in thyroid cancer patients less than 15 years old at the time of surgery. Pediatric thyroid carcinomas have a high rate of lymph nodal and distant metastases. Risk factors for recurrences and postoperative morbidity have not been assessed yet in a representative series. The group included 740 pediatric patients with thyroid cancer. Total thyroidectomy was performed in 426 (57.6%), lobectomy in 248 (33.5%), subtotal thyroidectomy in 58 (7.8%) cases, and 8 patients (1.1%) underwent partial lobectomy. The mean follow-up period was 115.8 months (range, 1.5-236.4 months). Recurrence was diagnosed in 204 cases (27.6%), including 73 local relapses (9.9%), 90 distant metastases (12.2%), and a combination of local and distant recurrences in 41 (5.5%) patients. Multivariate statistical assessment revealed the following independent parameters significantly associated with the risk of recurrent nodal disease: a young age at diagnosis, multifocal carcinomas, N1 status, and lack of neck lymph node dissection. For lung metastases, the significant risk factors were female gender, young age at diagnosis, and presence of symptoms. The observed 5- and 10-year survival for the entire group was 99.5% and 98.8%, respectively. Postoperative hypoparathyroidism was significantly associated with multifocal tumors, central compartment removal, and ipsilateral dissection. Total thyroidectomy followed by radioiodine therapy is an optimal treatment strategy that makes it possible to achieve a cure in a vast majority of pediatric patients with differentiated thyroid carcinomas. Risk of recurrence is strongly associated with tumor stage, extent of surgery, the young patient's age, and presence of symptoms at diagnosis.
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            Current management of pediatric thyroid disease and differentiated thyroid cancer

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              Inaugural Management Guidelines for Children with Thyroid Nodules and Differentiated Thyroid Cancer: Children Are Not Small Adults.

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rvdem
                Revista Venezolana de Endocrinología y Metabolismo
                Rev. Venez. Endocrinol. Metab.
                Sociedad Venezolana de Endocrinología y Metabolismo
                1690-3110
                June 2016
                : 14
                : 2
                : 137-143
                Affiliations
                [1 ] Hospital Militar Dr. Carlos Arvelo Venezuela
                [2 ] Hospital Militar Dr. Carlos Arvelo Venezuela
                Article
                S1690-31102016000200006
                fe86c70b-0f36-473e-b768-078d222a155d

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=1690-3110&lng=en
                Categories
                ENDOCRINOLOGY & METABOLISM

                Endocrinology & Diabetes
                Carcinoma diferenciado de tiroides,niños y adolescentes,folicular,papilar,metástasis,Differentiated thyroid carcinoma,children and adolescents,follicular,papillary,metastasis

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