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Papillary thyroid carcinoma in a 7-year-old boy presenting with a goitre without microcalcifications and enlarged
Maria Cecilia Schultze1, Cintia Castro-Correia2, Maria Bom-Sucesso3
1Pediatrics, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg.
Insights
Papillary thyroid carcinoma (PTC) in children is rare without microcalcifications. This case highlights the importance of suspecting thyroid cancer in children with goiter and lymphadenopathy, even without typical ultrasound findings.
Area of Science:
- Pediatric Endocrinology
- Oncology
- Radiology
Background:
- Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy in children, typically presenting as a nodule.
- Uncommon presentations of PTC, such as diffuse infiltration without microcalcifications, can occur.
Observation:
- A 7-year-old boy presented with goiter and cervical lymphadenopathy.
- Ultrasonography revealed a hypervascular goiter without microcalcifications but with bilateral cervical nodular formations.
- A lymph node biopsy confirmed metastatic thyroid cancer.
Findings:
- Histopathology confirmed papillary thyroid carcinoma (PTC).
- The patient underwent total thyroidectomy and complete neck dissection.
- Post-surgery, ablative radioactive iodine (RAI) therapy was administered.
- A metastatic lung nodule was identified after the first RAI treatment, requiring three additional treatments.
Implications:
- This case underscores the rarity of PTC presenting as diffuse infiltration without microcalcifications.
- Cervical lymphadenopathy in children warrants suspicion for thyroid cancer, even in the absence of typical ultrasound markers like microcalcifications.
- Early diagnosis and comprehensive treatment are crucial for managing pediatric thyroid cancer, including metastatic disease.
Abstract:
The most frequent type of thyroid malignancy in children is papillary thyroid carcinoma (PTC), which usually presents as a thyroid nodule, but may also present as a diffuse infiltration with microcalcifications. Herein, we report the case of an uncommon presentation of a PTC in a 7-year-old boy. The child was referred for a goiter with cervical lymphadenopathies. Ultrasonography showed a hypervascularised goiter without microcalcifications but with numerous bilateral cervical nodular formations. A lymph node biopsy revealed metastatic thyroid cancer, hence a total thyroidectomy and complete neck dissection were performed. Histopathology confirmed a PTC. Ablative 131I, 30 mCi was performed 4 months postsurgery. At the end of this treatment, a metastatic lung nodule was identified. Since then, another three ablative 131I treatments have been administered. Thyroid cancers presenting as a diffuse infiltration without microcalcifications are rare. In the presence of lymphadenopathies, thyroid cancer needs to be suspected, even without microcalcifications.
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