title: Pediatric Differentiated Thyroid Carcinoma of Follicular Cell Origin: Prognostic Significance of Histologic Subtypes.
abstract: BACKGROUND
  Thyroid cancers are rare in the pediatric age group, and unlike in adults, few data are available regarding the clinical implication of histologic subtypes in the pediatric population. The purpose of the current study was to determine the prognostic significance of histologic subtypes of differentiated thyroid cancer (DTC) in a large series of children and adolescents followed at a single institution.
  
  
  METHODS
  A retrospective review was conducted of all pediatric DTC patients who were treated and followed between 1988 and 2012. Sixty-two patients (median age at diagnosis 13.8 years, median age at follow-up 18 years, 77% female) were assessed. The most common subtypes included classic papillary thyroid carcinoma (PTC; 48%), diffuse sclerosing PTC (16%), and follicular variant PTC (15%); 37% were considered "high-risk" histologies based on adult criteria.
  
  
  RESULTS
  In a multivariate model, only extensive extrathyroidal extension (ETE), defined as the presence of two or more microscopic foci of tumor cells ≤1 mm in size each or any foci >1 mm in size invading beyond the thyroid capsule into perithyroid soft tissue or organs, was significantly associated with extent of disease at presentation. At last follow-up, 76% of subjects had no evidence of disease, 18% had persistent disease, and 5% had recurrent/progressive disease. Event-free survival was associated with extent of disease at presentation (p = 0.01), extensive ETE at diagnosis (p < 0.01), and male sex (p = 0.01), but not histologic subtype (p = 0.20).
  
  
  CONCLUSIONS
  Pediatric DTC carries an excellent prognosis. Extensive ETE at diagnosis was found to be an independent predictor of extent of disease at presentation, as well as event-free survival. Unlike in the adult population, "high-risk" histologic subtypes did not independently predict extent of disease at presentation or event-free survival in this pediatric population with DTC.
authors: 1 Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School , New Brunswick, New Jersey.
authors: Sadana
authors: S
authors: Balachandar
authors: 2 Department of Pediatric Surgery, Memorial Sloan Kettering Cancer Center , New York, New York.
authors: Michael
authors: M
authors: La Quaglia
authors: 3 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York.
authors: R Michael
authors: RM
authors: Tuttle
authors: 4 Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center , New York, New York.
authors: Glenn
authors: G
authors: Heller
authors: 5 Department of Pathology, Memorial Sloan Kettering Cancer Center , New York, New York.
authors: Ronald A
authors: RA
authors: Ghossein
authors: 6 Department of Pediatrics, Memorial Sloan Kettering Cancer Center , New York, New York.|7 Department of Pediatrics, Weill Cornell Medical College , New York, New York.
authors: Charles A
authors: CA
authors: Sklar
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis* / Q000473:pathology*; D000293:Adolescent; D000328:Adult; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology; D002291:Carcinoma, Papillary; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D013965:Thyroidectomy; D016896:Treatment Outcome; D055815:Young Adult