Title:Pediatric Differentiated Thyroid Cancer: When to Perform Conservative and Radical Surgery
Volume: 12
Issue: 4
Author(s): Claudio Spinelli, Leonardo Rossi, Jessica Piscioneri, Silvia Strambi, Alessandro Antonelli, Andrea Ferrari, Maura Massimino and Paolo Miccoli
Affiliation:
Keywords:
Adolescent surgery, pediatric age, pediatric surgery, thyroid cancer.
Abstract: Thyroid tumors affect all age groups, including children and adolescents. Malignant
cancer of the thyroid is a relatively uncommon disease in pediatric age. In the recent
decades the incidence of paediatric differentiated thyroid carcinoma (DTC) has increased.
DTC in paediatric age is rare and has an excellent prognosis.
Compared to adult counterpart, DTC in childhood presents some different features as follows:
larger volume at the diagnosis, more frequent multicentricity (both mono- and bilateral),
earlier local involvement of soft tissue of the neck, earlier lymph node involvement,
distant metastases 3-4 times more frequent (most often in the lungs and almost always
functional) and more common post-operatory recurrence; nevertheless, the prognosis of
DTC in childhood is better and the survival greater than in adult.
Because of unusual association between aggressive presentation and good prognosis, the
choice about the surgical treatment to perform in DTC is debatable, especially between
conservative and radical approach in TNM stage I pediatric patients. To date, total thyroidectomy
is the operation most often performed in children with DTC, although recently
conservative surgery has been performed in solitary unifocal nodule without evidence distant
metastases.
