Advanced insular thyroid carcinoma in a fourteen-year-old girl: Twenty-four years of follow-up

Insular thyroid carcinoma has become a separate entity among thyroid malignancies. It is regarded as intermediate in aggressiveness between well-differentiated and anaplastic thyroid carcinomas. Reports on the clinical course of children with insular thyroid carcinoma are rare. We report the case of a 14-year-old girl who was admitted to our thyroid outpatient ward in 1975 with a scintigraphic cold thyroid nodule and multiple enlarged cervical lymph nodes. Chest radiography showed metastases in both lungs. After total thyroidectomy and, central and modified unilateral radical neck dissection, the girl was given a dose of 80 mCi I-131. Posttherapeutic scan demonstrated diffuse tracer uptake in both lungs. A second dose of 200 mCi I-131 was administered 4 months later and another dose of 150 mCi I-131 in July 1976. Subsequently, whole-body scans showed inconspicuous tracer distribution and chest x-rays were normal. The patient was treated with levothyroxine and followed until 1982, when she left Vienna. In 1999, the patient was contacted for reexamination. She has been well and had had two healthy children. The patient was taking 150 mu g levothyroxine daily; she had a normal TSH value and her thyroglubulin was 0.3 ng/mL. Chest radiography and sonography of the neck showed no pathological findings. The paraffin sections of the patient's tumor were reexamined in 1999 and demonstrated the histologic characteristics of a poorly differentiated insular thyroid carcinoma (pT4a, pN1a, M1). These findings demonstrate that even in advanced stages, insular thyroid carcinoma treatment can be successful.