Clinical Outcomes of Diffuse Sclerosing Variant Papillary Thyroid Carcinoma in Pediatric Patients

Laryngoscope. 2022 May;132(5):1132-1138. doi: 10.1002/lary.29926. Epub 2021 Oct 29.


Objectives/hypothesis: The diffuse sclerosing variant of papillary thyroid carcinoma (DSV) may be more aggressive than conventional well-differentiated non-DSV related papillary thyroid carcinomas (N-PTC).

Study design: Retrospective chart review.

Methods: Retrospective review of clinical outcomes for patients 21 years of age or younger who underwent initial surgery for PTC at a single institution from January 1, 2005 to April 1, 2020. Genomic analysis was performed using targeted next-generation sequencing. Data were analyzed using Fischer's exact test and Kaplan-Meier curve log-rank test.

Results: Our cohort consisted of 72 patients, nine with DSV and 63 with N-PTC. Age at diagnosis was comparable (15.4 vs. 16.2 years, respectively, P = .46). DSV were more likely to be in the high-risk American Thyroid Academy pediatric risk group (100% vs. 41.3%, P = .004), to present with regional cervical lymph node metastases (100% vs. 60.3%, P = .036), and to present with distant metastases (67% vs. 22%, P = .005). No mortality seen in either group over 27.5 (interquartile range 14.8, 46.00) months average follow-up. Throughout the follow-up period, DSV were more likely to experience progression than N-PTC (hazard ratio = 5.7 [95% confidence interval 1.7-20.0; P = .0056]). In a subset of 19 patients with aggressive disease who had molecular testing as part of clinical care we detected RET fusions in nearly all DSV compared to a minority of N-PTC (83% vs. 15.4%, P = .0095).

Conclusions: Pediatric patients with DSV have more advanced disease at diagnosis and are more likely to experience progression of disease compared to patients with N-PTC. The prevalence of RET fusions in our cohort recapitulates the frequency of this alteration described in prior studies.

Level of evidence: 4 Laryngoscope, 132:1132-1138, 2022.

Keywords: Diffuse sclerosing variant; molecular analysis; papillary thyroid carcinoma; pediatric thyroid surgery; progression of disease.

MeSH terms

  • Adenocarcinoma*
  • Carcinoma, Papillary*
  • Child
  • Humans
  • Retrospective Studies
  • Thyroid Cancer, Papillary / pathology
  • Thyroid Cancer, Papillary / surgery
  • Thyroid Neoplasms* / pathology