Insular carcinoma of the thyroid in an adolescent: a case report and review of the literature

A 15-year-old girl was referred for a thyroid gland mass, which rapidly enlarged in the brief interval between initial evaluation and surgery. Fine needle aspiration of the mass suggested a diagnosis of papillary thyroid carcinoma. Upon pathological examination of this aggressive tumor, an "insular" pattern of tumor was identified. Insular carcinoma of the thyroid gland is unusual in the pediatric age group, however its aggressive nature and prognosis have important management implications for those physicians involved in the care of affected patients. Aggressive surgical debulking, very close observation of the course of disease, and adjunctive radioiodine therapy may all be indicated as were performed in this case. A description of the pathology of this condition, and a review of the clinical experience with insular carcinoma in childhood and adolescence are presented.