Kadir Alper KÜÇÜKER, İsa Burak GÜNEY, Zeynep YAPAR

Pediatrik diferansiye tiroid karsinomlarinda dirençli hastalık ile ilişkili faktörler

Amaç: Pediatrik hasta grubunda, endokrin dokudan köken alan karsinomlar içinde en sık tiroid karsinomu görülür. Pediatrik tiroid karsinomları hem lenf nodu ya da akciğer metastazına hem de tekrarlamaya daha çok meyillidir. Bu çalışmada, dirençli pediatrik diferansiye tiroid karsinomları ile ilişkili olabilecek klinik, patolojik ve genetik özellikler araştırıldı. Gereç ve Yöntem: I-131 radyoaktif iyot (RAİ) tedavisi almış 18 yaş ve altı 39 hasta çalışmaya dahil edildi. I-131 RAI tedavisi Amerika Tiroid Derneği (ATA) Rehberi’ne göre belirlendi. Hasta grubunun klinik ve postoperatif patolojik özellikleri geriye dönük olarak belirlenerek bu özellikler bakımından tek ve dirençli hastalık nedeniyle birden fazla tedavi almış hastalar istatistiksel olarak karşılaştırıldı. Birden fazla tedavi almış hastalarda ayrıca genetik analiz yapıldı. Bulgular: Hasta grubunun 31’i kadın, 8’i erkekti. Otuz dört hastada papiller tiroid karsinomu, 4 hastada folliküler tiroid karsinomu, 1 hastada mikst papiller-onkositik karsinom saptandı. Sekiz hasta dirençli hastalık nedeniyle birden fazla I-131 RAI tedavisi aldı. Bu hastalarda dirençli hastalık ile ilişkili olabilecek herhangi bir klinik ve patolojik özellik ile genetik mutasyon saptanmadı. Sonuç: Pediatrik tiroid karsinomu ender görülmesine rağmen sıklığı son yıllarda artış göstermektedir. Sınırlı sayıdaki hasta grubumuzda dirençli hastalık ile uyumlu olabilecek herhangi bir özellik izlenmemiştir. Kötü prognoz ile ilişkili olabilecek klinik, patolojik ve genetik özellikler daha geniş hasta serilerinde araştırılmalıdır.

Anahtar Kelimeler:

tiroid neoplazmları, iyot radyoizotopları, radyasyon tedavisi, genetik, pediatri

Factors associated with resistant disease in pediatric differentiated thyroid carcinomas

Purpose: Thyroid carcinoma is the most common carcinoma that originated from endocrine tissue in pediatric patients. Pediatric thyroid carcinomas are more prone to reveal lymph node or lung metastasis and recurrence. In this study, clinical, pathological and genetic features that may be related with resistant differentiated thyroid carcinoma in pediatric patients were investigated. Materials and Methodsː Thirty-nine pediatric patients who were 18 years old and below and were given 131I Radioactive Iodine (RAI) therapy were included to the study. 131I RAI therapy was planned in accordance with the American Thyroid Association (ATA) Guideline. Clinical and postoperative pathological features of patients were retrospectively determined and the patients who received single or multiple RAI therapy due to resistant disease compared statistically in terms of these features. Genetic analysis was also made in the patients who received multiple therapies. Resultsː Thirty-one patients were female and 8 patients were male. Thirty-four patients had papillary thyroid carcinoma, 4 had follicular thyroid carcinoma and 1 had mixed papillary-oncocytic carcinoma of patients. Eight patients received multiple I-131 RAI therapy cycles due to resistant disease. Any clinical, pathological feature and genetic mutation that would indicate resistant disease was not found in these patients. Conclusionː Although pediatric thyroid carcinoma is rarely seen, it has an increasing incidence in recent years. We were not able to reveal any feature related to resistant disease in our limited group. Clinical, pathological and genetic characteristics related to poor prognosis must be investigated with larger study groups.

Keywords:

thyroıd neoplasms, iodine radioisotopes, radiation therapy, genetics, pediatrics,

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