Mott Nicole, Kang Yena, Bruch Steven, Heider Amer, Thatcher Aaron
University of Michigan Medical School, Ann Arbor, Michigan.
University of Michigan, Department of Surgery, Ann Arbor, Michigan.
AACE Clin Case Rep. 2021 Mar 23;7(3):207-210. doi: 10.1016/j.aace.2021.01.005. eCollection 2021 May-Jun.
Pediatric thyroid cancer is rare. Most cases are well-differentiated thyroid cancers (WDTCs). However, gross laryngotracheal invasion of WDTCs is unusual. This report details the first case in English medical literature of a pediatric WDTC invading the trachea.
Thyroid stimulating hormone, free triiodothyronine, free thyroxine, thyroglobulin, parathyroid hormone, calcitonin, thyroglobulin antibody, chest magnetic resonance imaging, neck ultrasound, neck computed tomography, and fine needle aspiration were performed.
A 9-year-old boy with moderate persistent asthma presented with increasing upper respiratory symptoms. Spirometry suggested a fixed upper airway obstruction. Chest x-ray revealed a left tracheal shift, and chest magnetic resonance imaging identified a right thyroid mass. Thyroglobulin level was 809 ng/mL (normal, ≤33 ng/mL). Results of thyroid stimulating hormone, free triiodothyronine, free thyroxine, parathyroid hormone, calcitonin, and thyroglobulin antibody were normal. Neck ultrasound revealed 2 right thyroid lobe nodules. Neck computed tomography revealed tracheal compression. Fine needle aspiration of the largest nodule yielded atypia of undetermined significance. Bronchoscopy findings at his local hospital were concerning for tracheal invasion. He underwent total thyroidectomy, cricotracheal resection, reconstruction, and radioactive iodine therapy (220 mCi). Pathology demonstrated a well-differentiated papillary thyroid carcinoma without solid or diffuse sclerosing subtype components. Tumor cytogenetic and single nucleotide polymorphism microarray studies showed normal findings. One year postoperatively, neck ultrasound demonstrated no recurrence, and thyroglobulin levels were undetectable while on levothyroxine therapy.
Pediatric WDTC invading the trachea has not been reported.
小儿甲状腺癌较为罕见。大多数病例为分化良好的甲状腺癌（WDTC）。然而，WDTC出现大体上的喉气管侵犯并不常见。本报告详细介绍了英文医学文献中首例小儿WDTC侵犯气管的病例。
检测了促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、甲状腺球蛋白、甲状旁腺激素、降钙素、甲状腺球蛋白抗体，进行了胸部磁共振成像、颈部超声、颈部计算机断层扫描以及细针穿刺抽吸检查。
一名患有中度持续性哮喘的9岁男孩出现上呼吸道症状加重。肺功能测定提示存在固定性上气道梗阻。胸部X线显示气管左移，胸部磁共振成像发现右侧甲状腺肿块。甲状腺球蛋白水平为809 ng/mL（正常范围≤33 ng/mL）。促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、甲状旁腺激素、降钙素及甲状腺球蛋白抗体检测结果均正常。颈部超声显示右侧甲状腺叶有2个结节。颈部计算机断层扫描显示气管受压。对最大结节进行细针穿刺抽吸，结果显示意义不明确的非典型细胞。其当地医院的支气管镜检查结果提示气管受侵。他接受了全甲状腺切除术、环状气管切除术、重建术及放射性碘治疗（220 mCi）。病理检查显示为分化良好的乳头状甲状腺癌，无实体或弥漫性硬化亚型成分。肿瘤细胞遗传学和单核苷酸多态性微阵列研究结果均正常。术后1年，颈部超声显示无复发，在服用左甲状腺素治疗期间甲状腺球蛋白水平检测不到。
小儿WDTC侵犯气管此前未见报道。
