title: Metastatic insular thyroid carcinoma in the pediatric patient.
abstract: OBJECTIVE
  The clinical history of a pediatric patient with metastatic insular thyroid carcinoma will be reviewed. Previously reported cases will be examined to allow for comparison of prognosis.
  
  
  METHODS
  A 4-year-old female with the complaint of chronic cough, progressive shortness of breath, and weight loss for 2 months underwent cervical lymph node biopsy. The biopsy revealed metastatic thyroid carcinoma. Preoperative imaging was suspicious for miliary metastatic spread to the lungs.
  
  
  RESULTS
  Surgical intervention included total thyroidectomy with bilateral paratracheal and modified radical neck dissections. The right internal jugular vein and recurrent laryngeal nerve were removed at the time of surgery because of gross tumor invasion. Final pathologic finding revealed papillary thyroid carcinoma with insular variant features and bilateral regional metastasis. Postoperatively, the patient underwent radioactive iodine I 131 treatment.
  
  
  CONCLUSIONS
  Pediatric metastatic insular thyroid carcinoma is an uncommon form of thyroid malignancy requiring aggressive surgical treatment and adjuvant radioactive iodine.
authors.affiliation: Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, MS 39216-4505, USA. kdonnellan@ent.umsmed.edu
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Donnellan
authors.forename: Jeffery D
authors.initials: JD
authors.lastname: Carron
authors.forename: Steven A
authors.initials: SA
authors.lastname: Bigler
authors.forename: Richard O
authors.initials: RO
authors.lastname: Wein
mesh_terms: D001707:Biopsy, Needle; D018265:Carcinoma, Papillary, Follicular / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary*; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D037981:Neck Dissection; D009361:Neoplasm Invasiveness / Q000473:pathology; D011182:Postoperative Care; D018570:Risk Assessment; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes