Differentiated thyroid cancer in children and adults: same or distinct disease? Hormones (Athens)
Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland.Hormones (Athens, Greece) (Impact Factor: 1.2). 11/2006; 6(3):200-9.
Differentiated thyroid cancer (Dtc) is a rare disease, especially in children. Differences in the biology and clinical course of Dtc in children, when compared with adults, may be related both to pathogenesis as well as to clinical outcome of the disease. In childhood, the thyroid gland exhibits higher susceptibility to the carcinogenetic effect of ionizating radiation than in adulthood. Papillary thyroid cancer (Ptc) is more prevalent in children in comparison to adult patients. Among molecular events known to occur in papillary thyroid carcinoma, rEt/Ptc rearrangements exhibit higher prevalence in younger patients, while brAF mutations are very rare in this age group. cancer disease presents at a more advanced stage: 1) primary tumour at diagnosis is larger, especially in relation to the volume of the whole gland; 2) neck lymph node involvement is more commonly observed; 3) distant metastases are detected 3-4 times more frequently than in adults. the lungs are almost the sole distant metastatic site in children and pulmonary metastases are nearly always functional. Additionally, recurrence rates tend to be higher in children; nevertheless, cause-specific cancer mortality remains low. Up to now, thyroid cancer guidelines have been formulated on the basis of experience gained in the general population of patients. the peculiarities in childhood disease raise the question of whether it should be considered a distinct subtype, with specifically tailored therapy recommendations. A definitive answer to this question is not possible with the present state of knowledge. In the opinion of the authors, molecular analyses of childhood thyroid cancer may be crucial, as the clinical data have not satisfactorily answered this question.
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ABSTRACT: Children present a higher susceptibility to developing thyroid cancer after radioiodine exposure and also a higher frequency of functional metastases than adults. To assess the mRNA expression of the sodium/iodide (Na(+)/I(-)) symporter (NIS), the Pendred syndrome gene (PDS), thyroperoxidase (TPO), thyroglobulin (Tg) and TSH receptor (TSH-R) in normal thyroid tissues (NTTs) and papillary thyroid carcinomas (PTCs) among different age groups. Analysis included 59 samples: 21 NTTs and 38 PTCs, of which 21 were the classic type (CPTC) and 17 the follicular variant (FVPTC). Patients were divided into three age groups: I (n = 16) 5-21 years, II (n = 13) 22-59 years, and III (n = 10) 60-91 years. The relative mRNA expression of the five target genes was determinate by quantitative reverse transcription polymerase chain reaction (QRT-PCR). Expression of all genes was significantly higher in NTTs than in PTCs, and it was not age dependent in the NTT group. Among PTCs, the mean expression of PDS, TPO and TSH-R was significantly lower in group II than in group I. PDS, TPO and Tg expression was significantly lower in classic PTCs than in FVPTCs. The difference was related to a higher frequency of the BRAF(V600E) mutation in the former group. The finding of higher PDS, TPO and TSH-R mRNA expression in paediatric vs. adult primary tumour tissues supports the hypothesis that this might contribute to the increased functional activity of metastases in the paediatric group. The finding that mRNA expression of the target genes in NTT was not age dependent does not provide an explanation for the higher susceptibility in the paediatric group.
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ABSTRACT: Thyroid nodules are relatively rare in children and adolescents and have a prevalence between 0.2%-1.8%. They are more often malignant in children than in adults and thus an early diagnosis is extremely important. The aim of the study was to analyze the group of pediatric patients with nodular thyroid diseases. The authors processed the documentation of 66 pediatric patients with nodular thyroid disease who have been surgically treated at the Clinic of Otorhinolaryngology and Head and Neck Surgery, JFM CU and MFH in Martin during 2003-2007. Family history was positive in 32 patients (48.5%). Twenty-three patients (35%) had hyperfunction thyroid disease. Euthyroid status was found in 43 patients (65%). Ultrasonography examination was performed in all patients. Percutaneous aspiration biopsy was performed in 38 patients (58%) and peroperative histology in 40 patients (61%). Technecium (Tc)99m-scintigraphy was performed in 4 patients (6%). CT and MRI examination of the neck and upper mediastinum was indicated in one child. All patients were surgically treated with classical approach after achieving euthyroid stage. Total thyroidectomy was performed in 24 patients, hemithyroidectomy in 41 patients and isthmectomy was done in one patient. No severe postoperative complications were present. Thyroid diseases are the second most frequent endocrinopathy in children and adolescents with girls being more frequently affected. It is multidisciplinary problem requiring cooperation of specialists in different fields of medicine. In patients with thyroid diseases not responding to conservative treatment or with clinical signs of mechanical syndrom surgery is a causal therapy (Tab. 3, Ref. 20). Full Text (Free, PDF) www.bmj.sk.
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ABSTRACT: To analyze the correlation of central compartment lymph node metastasis (CCLNM) with different clinical factors of papillary thyroid microcarcinoma (PTMC). 117 patients of PTMC, 27 males and 90 females, aged 45 (16 - 68), underwent total thyroidectomy (or lobectomy) and central compartment lymph node dissection with or without lateral neck dissection. The correlation of CCLNM with age, sex, tumor size, tumor capsule, multifocality, and extrathyroid extension was analyzed. CCLNM was found in 42 of the 117 patients with the mean age of 40 +/- 9, significantly lower than that of the patients without CCLNM [(45 +/- 10), P < 0.05], and with the median tumor diameter of 0.75 cm, significantly longer than that of the patients without CCLNM (0.70 cm, P < 0.05). Both univariate and multivariate analyses showed that age and tumor size were significantly correlated with CCLNM (both P < 0.05). Classification tree analysis showed that the CCLNM rate of the patients younger than 43 was significantly higher than that of the patients older than 43. Sex, tumor capsule, multifocality, and extrathyroid extension were not associated with CCLNM. CCLNM occurs more frequently in the PTMC patients who are younger than 43 years and in those who have larger tumor.
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