endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg12978endoserg-12978Research ArticleОригинальное исследованиеOriginal studyКарцинома щитовидной железы на фоне диффузного токсического зоба у детейThyroid carcinoma in children with graves’ diseasehttps://orcid.org/0009-0005-7370-891XБричеваЭ. Б.BrichevaE. B.

Бричева Элла Байзетовна, аспирант, врач-детский эндокринолог 

117036, Москва, ул. Дмитрия Ульянова, д. 11 

Ella B. Bricheva

11 Dm. Ulyanova street, 117036 Moscow

e.bri4eva@yandex.ruhttps://orcid.org/0000-0001-6429-7198НагаеваЕ. В.NagaevaE. V.

Нагаева Елена Витальевна, д.м.н. 

Москва

Elena V. Nagaeva, MD, PhD

Moscow

nagaeva.elena@endocrincentr.ruhttps://orcid.org/0000-0002-6822-0435ПастуховаД. А.PastuhovaD. A.

Пастухова Дария Алексеевна 

ResearcherID: HCH-6755-2022;

Scopus Author ID: 58736417100

Москва

Dariya A. Pastuhova

ResearcherID: HCH-6755-2022;

Scopus Author ID: 58736417100

Moscow

Pastuhova.dariya@endocrincentr.ruhttps://orcid.org/0000-0001-6700-0812БабушкинА. В.BabushkinA. V.

Бабушкин Александр Владимирович

Москва

Aleksandr V. Babushkin

Moscow

babulevich@yandex.ruАртемоваА. М.ArtemovaA. M.

Артемова Алла Михайловна 

Москва

Alla M. Artemova

Moscow

alartymova@yandex.ruhttps://orcid.org/0000-0002-3734-6510БровинД. Н.BrovinD. N.

Бровин Дмитрий Николаевич, к.м.н

Москва

Dmitriy N. Brovin, MD, PhD

Moscow

brovin-dn@yandex.ruhttps://orcid.org/0000-0001-9621-5732БезлепкинаО. Б.BezlepkinaO. B.

Безлепкина Ольга Борисовна, профессор, д.м.н. 

Москва

Olga B. Bezlepkina, professor, Doctor of Medicine

Moscow

olga.bezlepkina@endocrincentr.ruhttps://orcid.org/0000-0002-2000-7694КалинченкоН. Ю.KalinchenkoN. Y.

Калинченко Наталья Юрьевна, к.м.н.

Москва

Nataliya Y. Kalinchenko, MD, PhD

Moscow

kalinnat@rambler.ruhttps://orcid.org/0000-0001-6891-0009УрусоваЛ. С.UrusovaL. S.

Урусова Лилия Сергеевна, д.м.н. 

Москва

Liliya S. Urusova, PhD

Moscow

Urusova.Liliya@endocrincentr.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation2024050320251841424Copyright © Бричева Э.Б., Нагаева Е.В., Пастухова Д.А., Бабушкин А.В., Артемова А.М., Бровин Д.Н., Безлепкина О.Б., Калинченко Н.Ю., Урусова Л.С., 20252025Бричева Э.Б., Нагаева Е.В., Пастухова Д.А., Бабушкин А.В., Артемова А.М., Бровин Д.Н., Безлепкина О.Б., Калинченко Н.Ю., Урусова Л.С.Bricheva E.B., Nagaeva E.V., Pastuhova D.A., Babushkin A.V., Artemova A.M., Brovin D.N., Bezlepkina O.B., Kalinchenko N.Y., Urusova L.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/12978ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Сочетание дифференцированной карциномы щитовидной железы (ДКЩЖ) и диффузного токсического зоба (ДТЗ) в детском возрасте встречается крайне редко. По данным литературы, распространенность ДКЩЖ при ДТЗ у взрослых составляет около 20%, у детей имеются единичные описания.

ЦЕЛЬ

ЦЕЛЬ. Определить распространенность и описать клинико-морфологические особенности карциномы щитовидной железы у детей с ДТЗ.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Ретроспективное наблюдательное исследование 77 пациентов в возрасте от 10 до 17 лет, перенесших тиреоидэктомию по поводу ДТЗ. Всем детям проведено клинико-инструментальное, цитологическое и патоморфологическое исследования в ГНЦ РФ ФГБУ «НМИЦ эндокринологии» Минздрава России в период с января 2022-го по сентябрь 2024 гг.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Частота встречаемости ДКЩЖ у детей с ДТЗ составила 10,4% (у 8 из 77 пациентов), при этом у пациентов с узлами на фоне ДТЗ – 21,7%. Примечательно, что даже при отсутствии данных за наличие узлового образования ЩЖ частота ДКЩЖ составила 5,5% и была выявлена только по данным гистологического исследования послеоперационного материала. По результатам патоморфологических заключений, классический подтип папиллярной карциномы щитовидной железы (ПКЩЖ) определен у 4 пациентов, папиллярная микрокарцинома – у 2, фолликулярный вариант ПКЩЖ – у 1, сочетание фолликулярной карциномы и классического подтипа папиллярной карциномы – у 1 ребенка.

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Высокая частота встречаемости ДКЩЖ на фоне ДТЗ у детей обусловливает необходимость повышенной онконастороженности при их ведении. При этом проведение тонкоигольной аспирационной биопсии (ТАБ) узлов, относящихся к 3–5 категории EU-TIRADS, является обязательным этапом обследования. При наличии узловых образований оперативный метод радикального лечения ДТЗ в детском возрасте является предпочтительным в связи с высоким риском их злокачественности.

BACKGROUND

BACKGROUND: The combination of differentiated thyroid carcinoma (DTC) and Graves’ disease (GD) in childhood is extremely rare. According to the literature, the prevalence of DTC in adult GD is about 20%, and only a few cases have been described in children.

AIM

AIM: To determine the prevalence and describe the clinical morphologic features of thyroid carcinoma in children with GD.

MATERIALS AND METHODS

MATERIALS AND METHODS: Retrospective study of 77 patients aged 10 to 17 years who underwent thyroidectomy for GD.

All patients underwent a comprehensive clinical-instrumental, cytologic and pathomorphologic study based on Endocrinology Research Centre in the period from January 2022 to September 2024.

RESULT

RESULT: The incidence of DTC in children with GD was 10.4% (8 out of 77 patients), while in patients with nodules on the background of DTC – 21.7%. Interestingly, even in the absence of evidence of a thyroid nodule, the incidence of DTC was 5.5% and was detected only on pathomorphologic examination. According to the pathomorphologic stedy, the classical subtype of PTC was determined in 4 patients, papillary microcarcinoma – in 2 patients, follicular variant of PTC – in 1 patient, combination of follicular carcinoma and classical subtype of papillary carcinoma – in 1 child.

CONCLUSION

CONCLUSION: The high incidence of DTC in children with GD requires increased oncologic vigilance in their management. Fine-needle aspiration (FNA) of nodular masses belonging to EU-TIRADS categories 3-5 is a mandatory step in the examination. In the presence of nodular masses in the thyroid gland, surgical method of radical treatment of GD in children is preferable due to their high risk of malignancy.

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The authors declare that there are no conflicts of interest present.