DIFFERENTIATED
THYROID CANCER – DIFFERENCES BETWEEN PEDIATRIC AND ADULT PATIENTS
1.The
thyroid parenchyma in children is especially sensitive to irradiation and susceptible
to carcinogenesis.
2. The risk
of underlying malignancy within a thyroid nodule is higher than in adults (x 4,
22 – 25 % vs. 5 – 10 %)
3.In
children, RET/PTC rearrangements are
more common (30 – 70 % vs. 10 – 20 %), while activating point mutations in the
signal transducing pathway, such as RAS and BRAF mutations, are less frequent
(< 10 % vs. 40 – 80 %)
4.Pediatric
patients with thyroid cancer present with more advanced disease at the time of
diagnosis compared to adult patients, having more frequent:
neck lymph node metastases (80 % vs.
20 – 50 %)
distant metastases (mainly
pulmonary, 9-30 % vs. 2 – 9 %)
5.Despite
more extensive disease at the time of diagnosis, pediatric patients have an
excellent prognosis, a higher expression of the sodium-iodine supporter (NIS)
increasing the degree of differentiation, and a better response to radioiodine
ablation therapy
6.Surgical
morbidity of thyroidectomy is higher in pediatric than in adult patients and
this emphasizes the importance of the “variable: operating surgeon”. The
surgeon who will perform thyroidectomy in a child with thyroid cancer should be
highly experienced in endocrine surgery
Σχόλια
Δημοσίευση σχολίου