Imaging and Clinical Features of Thyroid Cancer in Children and Adolescents

소아와 청소년에서 갑상선암의 영상의학적 소견과 임상적 특징

  • Lee, Kang-Young (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Hong, Hyun-Sook (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Lee, Eun-Hye (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Yi, Beom-Ha (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Lee, Hae-Kyung (Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Lee, Yong-Wha (Department of Laboratory Medicine and Genetics, Soonchunhyang University College of Medicine, Bucheon Hospital) ;
  • Koh, Eun-Suk (Department of Pathology, Soonchunhyang University College of Medicine, Bucheon Hospital)
  • 이강영 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 홍현숙 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 이은혜 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 이범하 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 이혜경 (순천향대학교 의과대학 부천병원 영상의학과학교실) ;
  • 이용화 (순천향대학교 의과대학 부천병원 진단검사의학과학교실) ;
  • 고은석 (순천향대학교 의과대학 부천병원 병리과학교실)
  • Published : 2011.08.01

Abstract

Purpose: To evaluate clinical and imaging features of pediatric thyroid cancer, including $BRAF^{V600E}$ mutation status in papillary thyroid cancer (PTC). Materials and Methods: We evaluated clinical findings including $BRAF^{V600E}$ status, ultrasound (US), and CT features of 13 pediatric patients with thyroid cancer. US findings were retrospectively analyzed for location, presence of a nodule, echotexture, echogenicity, calcifications, margin, shape, intranodular vascularity and abnormal lymph nodes. CT characteristics of the lesions, including attenuation, calcification, and measured degree of enhancement, were assessed. Results: The patients included three boys and ten girls with a mean age of 15.5 years (range 6-18 years). No patient was exposed to radiation. Palpable neck mass was the most common presentation. Eleven of 13 patients (84.6%) were diagnosed with PTC, and two (15.4%) had follicular thyroid cancer (FTC). Nine of 13 (69.2%) had high T-staging. $BRAF^{V600E}$ mutations were detected in 30.0% of PTC patients. A diffusely enlarged thyroid with calcifications (n = 2) or nodules (n = 7) was detected on US. All PTC nodules showed malignant US findings and one FTC displayed on indeterminate nodule. Nodules generally showed low attenuation on enhanced CT (n = 11/12). Conclusion: US demonstrated enlarged glands with calcifications or nodules. Diffusely enlarged thyroids with microcalcifications should be evaluated using fine-needle aspiration. A low attenuation nodule was a common finding on enhanced CT.

목적: 소아 갑상선암의 임상적 특징, 영상소견, 유두상암종 환자의 $BRAF^{V600E}$ 유전자 변이를 평가하였다. 대상과 방법: 13명의 소아 환자에서 $BRAF^{V600E}$ 유전자 변이를 포함한 임상소견, 초음파 및 컴퓨터단층촬영(CT) 소견을 후향적으로 평가하였다. 초음파 소견은 병변의 위치, 결절의 유무, 에코결, 에코음영, 석회화, 경계, 모양, 결절 내 혈류, 비정상 림프절 등을 분석하였다. CT 스캔은 병변의 감쇠도, 석회화, 조영정도를 평가하였다. 결과: 3명의 남아와 10명의 여아를 대상으로 하였고 평균나이는 15.5세였다(연령분포, 6세~18세). 이전에 방사선에 노출된 환자는 없었다. 만져지는 경부 종괴가 가장 흔한 증상이었다. 조직 소견은 유두상암종이 11명, 여포상암종이 2명이었고 13명 중 9명은 높은 T 병기를 보였다. $BRAF^{V600E}$ 변이는 유두상암종 환아 중 30%에서 발견되었다. 초음파 검사를 시행한 9명 중 7명은 결절의 형태로 보였고, 2명은 석회화를 동반한 미만성 갑상선 종대로 나타났다. 모든 유두상암종 결절은 악성 초음파 소견을 보였고 한 예의 여포상암종은 경계성 결절의 소견을 보였다. CT 스캔을 시행한 12명 중 11명이 조영증강 CT 스캔에서 저음영 결절의 형태를 보였다. 결론: 초음파 소견은 석회화를 동반한 미만성 종대 또는 결절의 소견을 보였다. 따라서 소아에서 갑상선의 미세석회화를 동반한 미만성 종대가 있을 경우 fine-needle aspiration을 시행하는 것이 필요하다고 생각된다. 조영증강 CT 스캔에서는 저음영 결절의 형태가 흔한 소견이었다.

Keywords

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