IMPE Abstracts

Introduction: Thyroid cancer is the most common endocrine neoplasm in childhood: incidence 1.6/million children <15 years, with a progressive increase over time. They present as mostly benign thyroid nodules, but up to 25% may be malignant. Well-differentiated papillary carcinoma is the most frequent in the general population, but in prepubescents it presents in a more advanced and aggressive way than in the adult population. Poorly differentiated thyroid carcinomas (PDTC), are extremely rare in children and adolescents, the existing literature is limited only to case reports, and the approach to this type of neoplasms in children becomes a challenge, as references cannot be extrapolated of the adult population due to lack of more consistent evidence.

Objective: A pediatric case of CPDT is presented, to sensitize clinicians -given its aggressiveness and severe impact on patients' lives- about the importance of correct and early diagnosis, as the central axis for optimal case-by-case management.

Clinical case: Adolescent 13 years old, with a history of mother and sister operated on for MNB- sister died at 17 years of age due to Glioblastoma- derived from euthyroid multinodular goiter, lobulated and hypoechoic 24 mm on US with Ac(-), FAP was performed with histology compatible with follicular neoplasia Bethesda IV, requiring total thyroidectomy, with hormone replacement therapy and management of transient 2nd hypoparathyroidism. Final biopsy reports 2 cell types: PDTC in the left lobe and PTC follicular variant, bilateral, for which the case is discussed with the endocrinology, radiology and nuclear medicine team to study metastatic disease that results (-) and is characterized according to international references of adult as intermediate risk, performing RAI with 100 mCi, with good subsequent ultrasound control.

Conclusions: In children with CPDT, it is important to clarify the precise diagnosis and therapy should be individualized according tointernational references (Turim and MCCS criteria) of the adult population to indicate: preoperative study, surgical treatment, use of RAI, as appropriate.