Noguchi Thyroid Clinic and Hospital Foundation, Beppu, Oita 874-0932, Japan.
Endocr J. 2013;60(5):629-35. doi: 10.1507/endocrj.ej12-0372. Epub 2013 Jan 17.
Children and adolescents represent 1-1.5% of all patients with thyroid cancer (TC). The vast majority of TC in children and adolescents is papillary TC; follicular TC (FTC) is exceedingly rare. In this study, we evaluate the clinical and pathological features of FTC in children and adolescents. We also report the risk factors for post-operative tumor recurrence and the associated outcomes. Twenty children and adolescents (under 21 years old) with FTC have been treated and followed at Noguchi Thyroid Clinic and Hospital Foundation since 1946. All patients underwent surgery (lobectomy, 11; subtotal thyroidectomy, 8; and total thyroidectomy, 1), and 8 patients received postoperative external beam radiation therapy. The incidence of FTC in children and adolescents was 1.9% among all FTC patients treated in our hospital. Histopathology revealed vascular and capsular invasion in 9 and 20 patients, respectively. The tumor recurrence rate in FTC with vascular invasion is significantly higher than in those without it (p = 0.038). No other factors were significant. Patients with recurrences were treated with completion thyroidectomy and ¹³¹I radioactive iodine therapy. There were no significant differences in the rates of disease-free survival or cause-specific survival when pediatric/adolescent FTC patients were compared to adults with FTC. FTC is very rare among children and adolescents, but the outcomes are similar to those observed among adults. Vascular invasion is poor prognostic indicator in pediatric/adolescent FTC patients.
儿童和青少年占所有甲状腺癌 (TC) 患者的 1-1.5%。儿童和青少年中绝大多数 TC 为乳头状 TC；滤泡性 TC (FTC) 极为罕见。在这项研究中，我们评估了儿童和青少年 FTC 的临床和病理特征。我们还报告了术后肿瘤复发的危险因素及其相关结果。自 1946 年以来，Noguchi 甲状腺诊所和医院基金会治疗并随访了 20 名患有 FTC 的儿童和青少年（年龄在 21 岁以下）。所有患者均接受手术治疗（11 例接受 lobectomy，8 例接受 subtotal thyroidectomy，1 例接受 total thyroidectomy），8 例患者接受术后外照射放疗。在我院治疗的所有 FTC 患者中，FTC 患儿的发病率为 1.9%。组织病理学显示，9 例和 20 例患者分别有血管和包膜侵犯。有血管侵犯的 FTC 肿瘤复发率明显高于无血管侵犯者（p = 0.038）。其他因素无显著差异。有复发的患者接受了 completion thyroidectomy 和 ¹³¹I 放射性碘治疗。与 FTC 成人患者相比，儿科/青少年 FTC 患者的无病生存率或特定病因生存率无显著差异。FTC 在儿童和青少年中非常罕见，但结果与成人观察到的相似。血管侵犯是儿科/青少年 FTC 患者预后不良的指标。
