title: Uncommon TERT Promoter Mutations in Pediatric Thyroid Cancer.
abstract: OBJECTIVE
  The aim of this study was to determine the rate and significance of TERT promoter mutations that have been recently described in adult thyroid cancer (TC) but not yet in the uncommonly occurring pediatric TC. Furthermore, the role of the BRAF(V600E) mutation in the clinical outcome of pediatric TC is unknown.
  
  
  METHODS
  The study included 55 pediatric (median age 16 years, range 9-18 years; 46 females) and 210 adult TC patients (median age 40 years, range 20-75 years; 155 females) seen during the same time period. DNA was isolated from TC tissues and subjected to direct sequencing. Genetic-clinicopathological correlations were analyzed.
  
  
  RESULTS
  Only one case of pediatric TC was found to harbor the C228T TERT promoter mutation (1.8%). The C250T mutation was not detected in any of the 55 pediatric TC. In contrast, there was a significantly higher rate of TERT promoter mutations in the adult patients (15.7%, 33/210) compared with the pediatric patients (p = 0.003). In addition, persistent/recurrent TC was seen in 8/12 (66.7%) pediatric patients harboring the BRAF(V600E) mutation versus 14/41 (34.1%) patients harboring the wild type BRAF (p = 0.05), and when only conventional papillary TC was examined, in 7/9 (77.8%) cases harboring BRAF(V600E) mutation versus 11/33 (33.3%) cases harboring wild type BRAF (p = 0.025).
  
  
  CONCLUSIONS
  This is the first study on TERT promoter mutations in pediatric TC, which revealed an exceedingly low prevalence, suggesting a limited role of these mutations in pediatric TC. This study also for the first time demonstrates an association of the BRAF(V600E) mutation with TC recurrence in pediatric patients.
authors.affiliation: 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .|2 Department of Medicine, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Ali S
authors.initials: AS
authors.lastname: Alzahrani
authors.affiliation: 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Ebtesam
authors.initials: E
authors.lastname: Qasem
authors.affiliation: 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Avaniyapuram Kannan
authors.initials: AK
authors.lastname: Murugan
authors.affiliation: 3 Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Hindi N
authors.initials: HN
authors.lastname: Al-Hindi
authors.affiliation: 2 Department of Medicine, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Dania
authors.initials: D
authors.lastname: AlKhafaji
authors.affiliation: 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Mai
authors.initials: M
authors.lastname: Almohanna
authors.affiliation: 4 Laboratory for Cellular and Molecular Thyroid Research, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Mingzhao
authors.initials: M
authors.lastname: Xing
authors.affiliation: 5 Department of Pediatrics, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Doha
authors.initials: D
authors.lastname: Alhomaidah
authors.affiliation: 1 Department of Molecular Oncology, King Faisal Specialist Hospital & Research Centre , Riyadh, Saudi Arabia .
authors.forename: Meshael
authors.initials: M
authors.lastname: AlSwailem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004252:DNA Mutational Analysis; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000235:genetics; D011401:Promoter Regions, Genetic; D048493:Proto-Oncogene Proteins B-raf / Q000235:genetics; D019098:Telomerase / Q000235:genetics*; D013964:Thyroid Neoplasms / Q000235:genetics*; D055815:Young Adult
chemical_list: C482119:BRAF protein, human; D048493:Proto-Oncogene Proteins B-raf; C509186:TERT protein, human; D019098:Telomerase