Carcinoma diferenciado da tireóide na infância / Childhood differentiated thyroid carcinoma

RESUMO

Os autores apresentam uma revisão de 12 casos de carcinoma da glândula tireóide em crianças, tratados na Seção de Cirurgia de Cabeça e Pescoço do Hospital do Câncer (INCa), no período entre 1986 e 1994. Trata-se de doença pouco freqüente, pois, neste levantamento, representou apenas 1,6% das 729 afecções cirúrgicas da tireóide e 10% dos 126 casos de carcinoma papilífero da glândula tireóide atendidos no período referido. A avaliação do sexo, forma de apresentação da doença, extensão do tumor inicial e resposta ao tratamento e evolução demonstraram que estas neoplasias acometem mais freqüentemente as meninas do que os meninos e, embora apresentem-se como forma de doença avançada desde a matrícula, geralmente respondem muito bem ao tratamento cirúrgico agressivo, o que proporciona, na maioria dos casos, um prognóstico bastante favorável.

ABSTRACT

The authors present a retrospective study of 12 childhood thyroid cancer seen at Hospital do Câncer (Rio de Janeiro - Brazil) from 1986 to 1994. The patient's age varied from seven to 13 years (median = 11 years), and all but one were female. Eleven children had papillary carcinoma and one follicular carcinoma. Seventy-five percent (nine patients) had cervical metastasis in presentation, and three presented pulmonary metastasis in any time of treatment. The tumor size ranged from 0,7 to six centimeters (median = 3 cm), 50%5 had capsular invasion all of them with cervical metastasis, tracheal invasion was detected in one patient, and the laryngeal recurrent nerve was partially compromised in two cases and had been functionally preserved in both. Only four patients were treated with less than total thyroidectomy but three of them had a second surgical procedure to complete thyroid resection since they developed cervical and/or distant metastasis. Radioactive iodine was used in eight patients with pulmonary metastasis or incomplete tumor resection. After a median follow-up period of four years all children are alive and with no evidence of disease. This is an infrequent children disease, and had represented only 1,6% of all surgical thyroid pathologies and 10% of thyroid papillary carcinoma treated in that period, and although tumor may be very aggressive in presentation, therapeutic result run with a long term prognostic when faced as a high risk disease.