J Korean Soc Radiol.  2011 Aug;65(2):181-189. 10.3348/jksr.2011.65.2.181.

Imaging and Clinical Features of Thyroid Cancer in Children and Adolescents

• Lee KY
• Hong HS
• Lee EH
• Yi BH
• Lee HK
• Lee YW
• Koh ES

• KMID: 1443483
• DOI: http://doi.org/10.3348/jksr.2011.65.2.181

Abstract

PURPOSE
To evaluate clinical and imaging features of pediatric thyroid cancer, including BRAFV600E mutation status in papillary thyroid cancer (PTC).
MATERIALS AND METHODS
We evaluated clinical findings including BRAF(V600E) status, ultrasound (US), and CT features of 13 pediatric patients with thyroid cancer. US findings were retrospectively analyzed for location, presence of a nodule, echotexture, echogenicity, calcifications, margin, shape, intranodular vascularity and abnormal lymph nodes. CT characteristics of the lesions, including attenuation, calcification, and measured degree of enhancement, were assessed.
RESULTS
The patients included three boys and ten girls with a mean age of 15.5 years (range 6-18 years). No patient was exposed to radiation. Palpable neck mass was the most common presentation. Eleven of 13 patients (84.6%) were diagnosed with PTC, and two (15.4%) had follicular thyroid cancer (FTC). Nine of 13 (69.2%) had high T-staging. BRAF(V600E) mutations were detected in 30.0% of PTC patients. A diffusely enlarged thyroid with calcifications (n = 2) or nodules (n = 7) was detected on US. All PTC nodules showed malignant US findings and one FTC displayed on indeterminate nodule. Nodules generally showed low attenuation on enhanced CT (n = 11/12).
CONCLUSION
US demonstrated enlarged glands with calcifications or nodules. Diffusely enlarged thyroids with microcalcifications should be evaluated using fine-needle aspiration. A low attenuation nodule was a common finding on enhanced CT.

MeSH Terms

Adolescent
Biopsy, Fine-Needle
Child
Factor IX
Humans
Lymph Nodes
Neck
Proto-Oncogene Proteins B-raf
Retrospective Studies
Thyroid Gland
Thyroid Neoplasms
Tomography, X-Ray Computed
Factor IX
Proto-Oncogene Proteins B-raf

Figure

• 

  Fig. 1 An 18-year-old girl with papillary thyroid cancer presenting with a palpable neck mass. BRAFV600E mutation analysis was positive. Transverse (A) gray-scale US images depict a typical malignant nodule with an irregular margin, marked hypoechogenicity with microcalcifications, and taller than wide shape with metastatic lymph nodes on the right at level III (B) (arrowheads). The pre (C) and post contrast-enhanced (D) neck CT scan show a slightly enhancing low attenuated nodule of the right thyroid gland. The PET-CT scan (E) demonstrates a hypermetabolic nodule in the right lobe p-SUV 8.9 (arrow) and lymph node metastases (arrowheads). Histopathology of these lymph nodes show metastasis. Note.-PET-CT = positron emission tomography-computed tomography

• 

  Fig. 2 A 13-year-old girl with papillary thyroid cancer. Transverse (A) gray-scale US images depict goitrous enlargement with numerous microcalcifications (arrow), (B) metastatic lymph node with calcifications and hypervascularity (arrowheads). The pre (C) and post (D) contrast-enhanced neck CT scan show diffuse heterogeneous enlargement of the thyroid gland with calcifications, a metastatic enhancing mass in the strap muscle, and both level IV nodes. Histologic examination (E) shows classical papillary thyroid cancer with optically clear nuclei and nuclear pseudoinclusions (H & E, × 400).

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