Clinical characteristics and treatment of thyroid cancer in children and adolescents: a retrospective analysis of 83 patients.

OBJECTIVE: To study the clinical characteristics, treatment, and prognosis of thyroid cancer in children and adolescents. METHODS: We performed a retrospective analysis of clinical data from 83 cases of thyroid cancer in children and adolescents from January 1990 to December 2010. We compared extra-thyroid extension, lymph node metastasis, distant metastasis, and prognosis between pediatric patients ≤12 years of age (27 cases) and those >12 years of age (56 cases). All the patients agreed to undergo thyroidectomy and endocrine therapy, and the consent was obtained from parents or guardians. RESULTS: Histopathology included papillary carcinoma in 67 cases, papillary carcinoma with partial follicular growth pattern in 1 case, papillary carcinoma with squamous metaplasia in 4 cases, follicular carcinoma in 7 cases, medullary carcinoma in 3 cases, and poorly differentiated carcinoma in 1 case. The total lymph node metastasis rate was 78.31%. Patients ≤12 years of age showed a higher rate of lymph node metastasis than the older group (92.59% vs. 71.43%, P=0.028). The incidence rate in females in the older group was higher than that in the younger group (80.36% vs. 59.26%, P=0.041). There were no significant differences in extra-thyroid extension, distant metastasis, survival rate, or recurrent disease between the two groups. CONCLUSIONS: The lymph node metastasis of thyroid cancer is higher in patients ≤12 years of age than in those >12 years of age; the incidence rate is higher in females than in males. Childhood thyroid cancer has a good prognosis, surgery being the most effective treatment. Choosing a reasonable surgery method and comprehensive postoperative treatment can achieve a cure and satisfactory survival rate.

Primary synovial sarcoma of the parapharyngeal space: a clinicopathologic study of five cases.

We report five cases of primary synovial sarcomas arising in the parapharyngeal space. The patients were all men with a median age of 35 years (range 22 to 41 years). The tumors were non-encapsulated solid masses ranging from 2.0 to 6.6 cm in size. Histologically, three cases were biphasic subtype, and the other two cases were monophasic subtype. Immunohistochemically, the tumor cells were strongly positive for bcl-2 and CD99, partly positive for CK and EMA, and negative for CD117, CD34, SMA and desmin in all five cases. S-100 protein was detected in one case. The presence of an SYT-SSX1 and/or SYT-SSX2 gene fusion resulting from t(X;18) was demonstrated from paraffin blocks by reverse transcriptase polymerase chain reaction in five cases. All five patients received tumor radical excision and postoperative radiotherapy, and two patients with pulmonary metastasis received additional chemotherapy. Follow-up data revealed that two patients with tumor size <5 cm were alive without disease for 54 and 57 months, one patient with tumor size <5 cm was alive with pulmonary metastasis for 78 months, and two patients with tumor size >5 cm died of disease 26 and 37 months after the diagnosis, respectively. Primary parapharyngeal synovial sarcoma is a rare variant that occurs more frequently in males than females. Accurate diagnosis depends on morphologic and immunohistochemical examination and proper molecular analysis. The prognosis is relatively good in those patients whose tumor size is less than 5 cm.

[Diagnosis and treatment of 11 cases with sinonasal neuroendocrine carcinoma].

OBJECTIVE: To explore the diagnosis and treatment and prognosis of sinonasal neuroendocrine carcinoma. METHODS: The clinical data of 11 cases with sinonasal neuroendocrine carcinoma treated in Zhejiang Cancer Hospital from 1998 to 2010 were analyzed retrospectively. Ten cases were small cell type and one case was atypical carcinoid. One case by only operation, one case by only radiotherapy, one case by only chemotherapy, two cases by radiotherapy and chemotherapy, 6 cases by combined treatment based on surgery (surgery combined with radiotherapy and chemotherapy). RESULTS: All cases have been followed up for 2 months to 12 years. Six cases by combined treatment one case died in 3 years and one case died in 4 years after treatment, one case has survived without tumor for 12 years and two cases have survived without tumor for 8 years, one case was still in treatment. Five cases of other treatment programs, four cases died in 12 months, one case died in 18 months. CONCLUSIONS: There's no standard treatment plan. Combined treatment based on surgery should be adopted to nasal neuroendocrine carcinoma. Reccurrence is frequent and the prognosis is poor. The key to improving the survival rate of the disease is early accurate diagnosis and combined treatment.

[Treatment for thyroid papillary cancer after nonstandard operation].

OBJECTIVE: To evaluate the disadvantage of nonstandard operation for thyroid papillary cancer, and the value of re-operation. METHODS: Eight hundred and ninety three thyroid papillary cancer patients (332 patients who received nonstandard operation received re-operation and 561 patients who received first standard operation in Zhejiang Cancer Hospital from January 1990 to January 2000) were retrospectively reviewed. RESULTS: Pathological results confirmed that there were 53.9% cases with residual cancer in re-operative specimen. The parathyroid was preserved in 74.1% cases in re-operation and 93.0% cases in standard operation (P < 0.01). The recurrent laryngeal nerve was injured in 3.3% cases in reoperation and 1.2% cases in standard operation (P < 0.05). The positive neck lymph node was 39.2% and 37.4% (P > 0.05), the 5-year local recurrence rate was 7.5% and 3.7% (P < 0.01), the total 5-year and 10-year cum-survival rates were 90.2%, 84.4% in patients with re-operation and 94.0%, 92.5% in patients with standard operation. The 10-year cum-survival rate were 67. 8% in patients with recurrence and 92. 9% in patients with non-recurrence in primary site respectively. Statistical analysis showed that the cancer recurrence influences the survival rate significantly (P < 0.01). CONCLUSIONS: In consideration of the higher residual tumor rate in patients who received nonstandard operations, the re-operations were necessary. But the re-operation could also leads to higher recurrence rate and more functional injuries. The standardized primary operation should therefore be formulated and advocated.

[Treatment and survival analysis of pyriform sinus cancer].

OBJECTIVE: To evaluate the efficacy of surgery for the patients with pyriform sinus carcinoma and analyze the prognostic factors related to the cancer. METHODS: Between December 1995 and December 2002, 62 patients with pyriform sinus cancer were treated in Zhejiang Tumor Hospital. There were 13 patients staged T1, 17 T2, 12 T3, 20 T4. Four patients received preoperative radiation and 40 patients had post-operative radiation. Among 62 patients, 33 patients were treated by partial laryngectomy, 29 patients were treated by total laryngectomy. RESULTS: The survival rate was calculated with Kaplan-Meier method. The overall 3- and 5-year survival rates were 42.3% and 27.8%, respectively. The 3-year survival rate between partial and total laryngectomy was 51.9% and 29.9%. The 5-year survival rate between partial and total laryngectomy was 39.5% and 11.2% (chi2 = 4.14, P<0.05). Early stage and combined modality therapy were the independent favorable prognostic factors. CONCLUSIONS: Early diagnosis with treatment and combined treatment are the most important factors influencing the survival of patients with pyriform sinus carcinoma. Partial laryngopharyngectomy is a suitable treatment for early and selected advanced pyriform sinus carcinoma with a good function and oncologic outcome.