4. Carcinoma diferenciado de tiroides (CDT): presentacion y seguimiento en niños y adolescentes.

PAPENDIECK P; BRASLAVSKY D; CHIESA A; VENARA M; GRUÑEIRO PAPENDIECK L

Lima Perú.

Congreso; XX Reunion Anual de SLEP; 2008

SLEP

DTC is the most frequent endocrine malignancy in childhood. Presentation and long term follow up vary from that described for adults. To report the clinical findings, treatment and follow-up of pediatric DTC, we analyzed the clinical charts and anatomopathological reports of 41 patients with DTC (8males)(6,2−19,5 years)(35 pubertal) followed up for 0,16 −13,1 years at the Endocrinology Unit between 6/88 and 6/08. Results: 31 patients consulted with a thyroid mass, 7 had also palpable cervical lymph nodes (CLN) and 10 multinodular goiter. Tumor size by palpation was < 1cm: 2, 1−4cm: 28 and > 4cm: 10. All underwent total thyroidectomy; 3(7,3%) presented recurrent laryngeal nerve paralysis and 8(20%) permanent hypoparathyroidism.17 had CLN involvement, 4 distant LN metastases (MTS) and 4 lung MTS. FNAB (n:35) was diagnostic in 37,1% and suspicious in 40%. Anatomopathological studies revealed 36 papillary and 5 follicular carcinomas, 23 multifocal and 19 with extracapsular extension. All underwent postoperative radioiodine remnant ablation and l-thyroxin suppressive therapy. 6 recurred: 3 regional LN, 1 mediastinal LN, 1 in lung and 1 indeterminate location. At 5 years of follow up (n:20) 70% had no evidence of disease. In children DTC mainly presented as a palpable single thyroid mass (31/41) had already LN involvement (56%) and was predominantly papilar (36/41) with multifocal location (56%) and pulmonary MTS (12%). FNAB was a useful tool for diagnosis and therapeutic approach allowed eradication of the disease in 70% of patients followed up for 5 years.31 patients consulted with a thyroid mass, 7 had also palpable cervical lymph nodes (CLN) and 10 multinodular goiter. Tumor size by palpation was < 1cm: 2, 1−4cm: 28 and > 4cm: 10. All underwent total thyroidectomy; 3(7,3%) presented recurrent laryngeal nerve paralysis and 8(20%) permanent hypoparathyroidism.17 had CLN involvement, 4 distant LN metastases (MTS) and 4 lung MTS. FNAB (n:35) was diagnostic in 37,1% and suspicious in 40%. Anatomopathological studies revealed 36 papillary and 5 follicular carcinomas, 23 multifocal and 19 with extracapsular extension. All underwent postoperative radioiodine remnant ablation and l-thyroxin suppressive therapy. 6 recurred: 3 regional LN, 1 mediastinal LN, 1 in lung and 1 indeterminate location. At 5 years of follow up (n:20) 70% had no evidence of disease. In children DTC mainly presented as a palpable single thyroid mass (31/41) had already LN involvement (56%) and was predominantly papilar (36/41) with multifocal location (56%) and pulmonary MTS (12%). FNAB was a useful tool for diagnosis and therapeutic approach allowed eradication of the disease in 70% of patients followed up for 5 years.